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

Individual provider Physician Assistant · NPI 1750871455

Kacie Wallace, MS, PA-C is a Physician Assistant in Detroit, Michigan. Licensed in Michigan. Registered with an NPI since 2018.

Licensed in
MI
In the registry since
2018
What do these letters mean?
MS — Master of Science
A graduate science degree.
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

22101 Moross Rd
Detroit, MI 48236-2148
Phone: (313) 343-4000
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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 1151843 (MI)

Record details

NPI number1750871455
Entity typeIndividual (Type 1)
GenderFemale
Credentials MS , PA-C
Sole proprietorNo
NPI enumeratedMay 17, 2018
Last updated in NPPESSeptember 15, 2019

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