Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Kenneth Nicley, PA

Individual provider Physician Assistant · NPI 1306252598

Mr. Kenneth Nicley, PA is a Physician Assistant in Maynardville, Tennessee. Graduated from Lincoln Memorial University Medical Department in 2013, 13 years ago. Practices with Summit Medical Group, PLLC, a 636-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
13
Trained at
Lincoln Memorial University Medical Department
Licensed in
TN
In the registry since
2014
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

149 Durham Dr
Maynardville, TN 37807-2925
Phone: (865) 992-2221
Fax: (865) 992-2251
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2416 (TN)

Record details

NPI number1306252598
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 8, 2014
Last updated in NPPESJanuary 21, 2015

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolLINCOLN MEMORIAL UNIVERSITY MEDICAL DEPARTMENT
Graduated 2013 (13 years in practice)
Group practice Summit Medical Group, Pllc — 636 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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