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General NPI Number Information
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NPI Number | 1376942375
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Entity Type | Individual
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Provider Name | STEPHEN NETHERLAND PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | SGT KIM'S SCMH BLDG 6370 CAMP HUMPHREY'S SOUTH KOREA
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City | APO
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State | AP
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Zip | 96251
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Country | US
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Telephone | 315-737-5070
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 333 BOX 6871
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City | APO
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State | AP
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Zip | 96251-0069
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Country | US
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Telephone | 315-737-5070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1117312
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License Number State | GA
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