Individual provider Active NPI

Tristian Nicole Martin, NP

  • Family Nurse Practitioner
  • Monticello, KY
National Provider Identifier
1407671316
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4027956 Issued in KY
Practice address
895 N Main St
Monticello, KY 42633-1580
Phone
(606) 396-3006
NPI assigned
Nov 18, 2024
Last updated
Nov 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4027956 KY Primary

Addresses

Primary practice location

895 N Main St
Monticello, KY 42633-1580

Mailing address

895 N Main St
Monticello, KY 42633-1580
Phone (606) 396-3006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241206000333 KY Practitioner - Nurse Practitioner 8628504255 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Kentucky, PLLCGroup PAC ID 0143525998, 213 clinicians

Practice addresses (Care Compare)

895 N Main St
Monticello, KY 42633-1580
Phone (606) 396-3006

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4027956KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brock Medical, LLC CurrentSince Nov 1, 2024 Accepting new patients
Upperline Healthcare, PC CurrentSince Aug 25, 2025 Accepting new patients
Fast Pace Kentucky PLLC Family CurrentSince Nov 1, 2024 Accepting new patients
Upperline Healthcare, PC CurrentSince Aug 25, 2025 Accepting new patients
Fast Pace Kentucky PLLC CurrentSince Nov 1, 2024 Accepting new patients
Fast Pace Kentucky, PLLC CurrentSince Nov 1, 2024 Accepting new patients
Fast Pace Kentucky, PLLC Past Accepting new patients

Locations

1873 Cumberland Falls Hwy
Corbin, KY 40701
Phone (606) 404-6450

1475 Nashville Rd
Franklin, KY 42134
Phone (270) 813-1111

1649 Highway 192 W
London, KY 40741
Phone (606) 330-0055

895 N Main St
Monticello, KY 42633
Phone (606) 396-3006

115 Tradepark Dr
Ste A
Somerset, KY 42503
Phone (606) 678-5708

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1407671316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 N MAIN ST",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "426331580",
            "telephone_number": "606-396-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 N MAIN ST",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "426331580",
            "telephone_number": "606-396-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "TRISTIAN",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "4027956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, KY

Sources for this page

Verify at the official NPI Registry.