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

Individual provider Physician Assistant · NPI 1770523557

Theodore Prins Kistemaker, PA-C is a Physician Assistant in Winston Salem, North Carolina. Qualified in 2002, 24 years ago. Practices with Wake Forest University Health Sciences, a 2,621-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
24
Licensed in
NC
In the registry since
2006
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

3333 Brookview Hills Blvd Ste 207
Winston Salem, NC 27103-5661
Phone: (336) 765-5250
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 103628 (NC)

Record details

NPI number1770523557
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 8, 2006
Last updated in NPPESApril 28, 2014

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Wake Forest University Health Sciences — 2621 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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