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

Kimberley Glenn, PA

Individual provider Physician Assistant · NPI 1659601649

Kimberley Glenn, PA is a Physician Assistant in Woodstock, Georgia. Qualified in 2015, 11 years ago. Practices with Northside Primary Care Professional Services, LLC, a 311-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Georgia and New York.

Years since qualifying
11
Licensed in
GA, NY
In the registry since
2010
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

960 Woodstock Pkwy Ste 300
Woodstock, GA 30188-4866
Phone: (770) 517-2145
Fax: (770) 517-2147
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 007388 (GA)
Physician Assistant Taxonomy 363A00000X · Licence 013821 (NY)

Record details

NPI number1659601649
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorYes
NPI enumeratedJanuary 13, 2010
Last updated in NPPESJanuary 10, 2017

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Northside Primary Care Professional Services,Llc — 311 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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