# FAST PACE KENTUCKY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598335481
- **Authorized official:** SYDNI CLEMMONS (CREDENTIALING MANAGER)
- **Authorized official phone:** (901) 351-1791

## Contact information

- **Practice address:** 1475 NASHVILLE RD, FRANKLIN, KY 42134-6961
- **Practice address phone:** (901) 351-1791
- **Mailing address:** PO BOX 306414, NASHVILLE, TN 37230-6414
- **Mailing address phone:** (901) 351-1791

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | — | NULL | Yes |
| 174400000X | Specialist | — | — | Yes |

## Other

- **Enumeration date:** 07/01/2021
- **Last updated:** 07/01/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000 | MEDICAID PENDING | KY |