Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kyle Michael Wiedemer, PA-C

Individual provider Physician Assistant · NPI 1750905972

Kyle Michael Wiedemer, PA-C is a Physician Assistant in Winchester, Kentucky. Qualified in 2021, 5 years ago. Practices with Clark Regional Physician Practices LLC, a 45-clinician group and accepts Medicare assignment. Licensed in Kentucky.

Years since qualifying
5
Licensed in
KY
In the registry since
2020
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

225 Hospital Dr Ste 110
Winchester, KY 40391-7624
Phone: (859) 737-6572
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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 TC115 (KY)

Record details

NPI number1750905972
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedJune 3, 2020
Last updated in NPPESNovember 2, 2021
Certification dateAugust 18, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Clark Regional Physician Practices Llc — 45 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Winchester