Provider Demographics
NPI:1932631009
Name:NETHERS, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:NETHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:150 WELLESLEY TRADE LN STE 204
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5593
Mailing Address - Country:US
Mailing Address - Phone:919-230-4016
Mailing Address - Fax:919-230-4017
Practice Address - Street 1:150 WELLESLEY TRADE LN STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5593
Practice Address - Country:US
Practice Address - Phone:919-230-4016
Practice Address - Fax:919-230-4017
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ62256207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology