Organization
FAST PACE MISSISSIPPI, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYDNI CLEMMONS (CREDENTIALING MANAGER)
(901) 351-1791
Entity
Organization
Contact information
Practice address
517 CITY AVE S, RIPLEY, MS 38663
(662) 587-8206
(662) 587-8207
Mailing address
6550 CAROTHERS PKWY STE 225, FRANKLIN, TN 37067-6662
(931) 253-1110
(931) 253-1110
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07277821
—
MS
Enumeration date
09/21/2017
Last updated
10/15/2021
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