Healthcare Provider Details

I. General information

NPI: 1376942375
Provider Name (Legal Business Name): STEPHEN KYLE NETHERLAND PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 02/08/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 E COLLEGE ST
DICKSON TN
37055-2032
US

IV. Provider business mailing address

1402 LOCK B RD S
CLARKSVILLE TN
37040-8323
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-7016
  • Fax:
Mailing address:
  • Phone: 931-302-6904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6876
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: