Provider Demographics
NPI:1376942375
Name:NETHERLAND, STEPHEN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:NETHERLAND
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 333 BOX 6871
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96251-0069
Mailing Address - Country:US
Mailing Address - Phone:315-737-5070
Mailing Address - Fax:
Practice Address - Street 1:SGT KIM'S SCMH
Practice Address - Street 2:BLDG 6370 CAMP HUMPHREY'S SOUTH KOREA
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96251
Practice Address - Country:US
Practice Address - Phone:315-737-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1117312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant