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Organization
FAST PACE KENTUCKY PLLC
Active
Organization
FAST PACE KENTUCKY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYDNI CLEMMONS (CREDENTIALING MANAGER)
(901) 351-1791
Entity
Organization
Contact information
Practice address
1475 NASHVILLE RD, FRANKLIN, KY 42134-6961
(901) 351-1791
Mailing address
PO BOX 306414, NASHVILLE, TN 37230-6414
(901) 351-1791
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NULL
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
MEDICAID PENDING
KY
Enumeration date
07/01/2021
Last updated
07/01/2021
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