MEDICARE: STEPHEN KYLE NETHERLAND PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	6876	TN

General Provider Information

NPI Number	:	1376942375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN KYLE NETHERLAND PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	1402 LOCK B RD S
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-8323
Country	:	US
Telephone Number	:	931-302-6904
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 E COLLEGE ST
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2032
Country	:	US
Telephone Number	:	615-560-7016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	02/08/2026

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