Provider Demographics
NPI:1316642234
Name:KENOBBIE, KYLE ALLAN (PA-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ALLAN
Last Name:KENOBBIE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 HIGHWAY 54 W STE 4200
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2112
Mailing Address - Country:US
Mailing Address - Phone:678-829-1060
Mailing Address - Fax:678-829-1099
Practice Address - Street 1:1267 HIGHWAY 54 W STE 4200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2112
Practice Address - Country:US
Practice Address - Phone:678-829-1060
Practice Address - Fax:678-829-1099
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant