Provider Demographics
NPI:1790057438
Name:WIMMER, KACEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KACEY
Middle Name:
Last Name:WIMMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KACEY
Other - Middle Name:
Other - Last Name:BRODIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2401 E ST NW
Mailing Address - Street 2:L209
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20520-5712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 E ST NW
Practice Address - Street 2:L209
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20520-5712
Practice Address - Country:US
Practice Address - Phone:202-792-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA200002199363A00000X
ORPA156855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant