NPIMap

Organization Active NPI

Fast Pace Kentucky PLLC

  • Rural Health Clinic/Center
  • Dry Ridge, KY
National Provider Identifier
1922842285
Registry record updated Jun 21, 2024
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
38 Broadway Street
Dry Ridge, KY 41035
Phone
(859) 300-0694
NPI assigned
Jun 21, 2024
Last updated
Jun 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Authorized official

Name
Selena Gurley
Title
VP
Phone
(931) 253-1110

Specialties & licenses 1

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

Addresses

Primary practice location

38 Broadway Street
Dry Ridge, KY 41035

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
O20240801001386 KY Part A Provider - Rural Health Clinic 0143525998 Practice locations: Dry Ridge, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922842285. Details of each certification follow.

Rural health clinic certification: CCN B03965

Legal name
FAST PACE KENTUCKY, PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 26, 2024
Last certification
Nov 26, 2024
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Dec 21, 2015 in KY
Enrollment address
38 Broadway St
Dry Ridge, KY 41035-9762

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
18D2305234Fast Pace Kentucky, PLLC38 Broadway Street, Dry Ridge, KY 41035Certificate of waiverMay 27, 2028

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 Employee Jan 1, 2024
Barry Louis Taylor Individual 5% Or Greater Direct Ownership InterestOwner May 1, 2019 33%
Christy Littlejohn Individual W-2 Managing Employee Jan 1, 2024
Karen Denise Daingerfield Individual 5% Or Greater Direct Ownership InterestOwner May 1, 2019 33%
Dana Kay Martin Individual 5% Or Greater Direct Ownership InterestOwner May 1, 2019 33%

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": "1718928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1922842285",
    "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": "38 BROADWAY STREET",
            "city": "DRY RIDGE",
            "state": "KY",
            "postal_code": "41035",
            "telephone_number": "859-300-0694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE KENTUCKY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-21",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "GURLEY",
        "authorized_official_first_name": "SELENA",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "931-253-1110"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dry Ridge, KY

Sources for this page

Verify at the official NPI Registry.