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

Kacie Wallace Gonzales

Individual provider Physician Assistant · NPI 1649899600

Kacie Wallace Gonzales is a Physician Assistant in Bryan, Texas. Qualified in 2020, 6 years ago. Works from 2 locations and accepts Medicare assignment. Licensed in Oklahoma and Texas.

Years since qualifying
6
Licensed in
OK, TX
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

2215 E Villa Maria Rd Ste 110
Bryan, TX 77802-2585
Phone: (979) 776-2000
Fax: (866) 733-2572
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2435 Harvey Mitchell Parkway South, College Station, TX 77845 — (979) 776-2000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 14298 (TX)
Physician Assistant Taxonomy 363A00000X · Licence 3181 (OK)

Record details

NPI number1649899600
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedApril 10, 2020
Last updated in NPPESJanuary 29, 2026
Certification dateJanuary 29, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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