NPIMap

Organization Active NPI

Fast Pace Kentucky PLLC

  • Rural Health Clinic/Center
  • Paducah, KY
National Provider Identifier
1124810536
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAST PACE KENTUCKY PLLC
Practice address
4755 Village Square Dr
Paducah, KY 42001-7438
Phone
(931) 253-1110
NPI assigned
May 21, 2025
Last updated
May 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa Harlan
Title
Director of Credentialing
Phone
(615) 948-9639

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

4755 Village Square Dr
Paducah, KY 42001-7438

Mailing address

PO Box 306414
Nashville, TN 37230-6414
Phone (931) 253-1110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250606002067 KY Part A Provider - Rural Health Clinic 0143525998 Practice locations: Paducah, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124810536. Details of each certification follow.

Rural health clinic certification: CCN B08906

Legal name
FAST PACE KENTUCKY, PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 24, 2025
Last certification
Nov 24, 2025
Ownership / control type
1B
Organization structure
OtherProprietary
Enrollment address
4755 Village Square Dr
Paducah, KY 42001-7438

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2319339Fast Pace Kentucky PLLC4755 Village Square Drive, Paducah, KY 42001Certificate of waiverFeb 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Fast Pace Kentucky PLLC44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Melissa Harlan Individual W-2 Managing EmployeeDirector of Pe Jan 1, 2024 100%
Operational/Managerial ControlDirector of Pe Jan 1, 2024 100%
Barry Louis Taylor Individual 5% Or Greater Direct Ownership InterestOwner May 1, 2019 33.3%
Christy Littlejohn Individual W-2 Managing EmployeeSr Manager Jan 1, 2024 100%
Operational/Managerial ControlSr Manager Jan 1, 2024 100%
Karen Denise Daingerfield Individual 5% Or Greater Direct Ownership InterestOwner May 1, 2019 33.3%
Dana Kay Martin Individual 5% Or Greater Direct Ownership InterestOwner May 1, 2019 33.3%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1124810536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306414",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306414",
            "telephone_number": "931-253-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 VILLAGE SQUARE DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420017438",
            "telephone_number": "931-253-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE KENTUCKY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-21",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A",
        "authorized_official_last_name": "HARLAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "615-948-9639"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

Verify at the official NPI Registry.