Healthcare Provider Details

I. General information

NPI: 1942940820
Provider Name (Legal Business Name): KACIE E WHEELER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W GIRARD AVE
PHILADELPHIA PA
19123-1531
US

IV. Provider business mailing address

321 W GIRARD AVE
PHILADELPHIA PA
19123-1531
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-3808
  • Fax:
Mailing address:
  • Phone: 215-685-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberO2025180
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: