MEDICARE: FPM HOLDINGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1922990514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FPM HOLDINGS LLC

Provider Business Mailing Address
First Line	:	PO BOX 681029
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-1029
Country	:	US
Telephone Number	:	931-253-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	7545 ALEXANDRIA PIKE
Second Line	:
City	:	ALEXANDRIA
State	:	KY
Zip	:	41001-1041
Country	:	US
Telephone Number	:	859-365-5856
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, CREDENTIALING/ENROLLMENT
Name	:	MELISSA HARLAN
Credential	:
Telephone Number	:	615-948-9639

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	07/17/2025

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