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

Kyle Glenn Obendorf

Individual provider Medical Physician Assistant · NPI 1093161564

Kyle Glenn Obendorf is a Physician Assistant in Winston Salem, North Carolina. Qualified in 2016, 10 years ago. Practices with Wake Forest Health Network LLC, a 271-clinician group, accepts Medicare assignment and offers telehealth. Licensed in North Carolina.

Years since qualifying
10
Licensed in
NC
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

3333 Brookview Hills Blvd Ste 207
Winston Salem, NC 27103-5661
Phone: (367) 655-2503
Fax: (336) 659-0953
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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 0010-06517 (NC)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 001006517 (NC)

Record details

NPI number1093161564
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 13, 2016
Last updated in NPPESOctober 4, 2022
Certification dateSeptember 29, 2020

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Wake Forest Health Network Llc — 271 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Winston Salem