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

Kordell Alan Koepnick, PA

Individual provider Medical Physician Assistant · NPI 1770289621

Kordell Alan Koepnick, PA is a Physician Assistant in Boise, Idaho. Qualified in 2022, 4 years ago. Practices with United Wound Healing Ps, a 33-clinician group, works from 3 locations, accepts Medicare assignment and offers telehealth. Licensed in Idaho, Oregon and Washington.

Years since qualifying
4
Licensed in
ID, OR, WA
In the registry since
2023
Specialties on file
9
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

500 S 8th St
Boise, ID 83702-7107
Phone: (855) 255-1750
Fax: (855) 255-0905
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 5200 Meadows Rd Ste 200, Lake Oswego, OR 97035-0086 — (855) 255-1750
  • 413 29th St Ne Ste I, Puyallup, WA 98372-7154 — (855) 255-1750

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2450 (ID)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA-2450 (ID)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA61460460 (WA)
Physician Assistant Taxonomy 363A00000X · Licence PA219548 (OR)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA61460460 (WA)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA219548 (OR)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA-2450 (ID)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA219548 (OR)
Physician Assistant Taxonomy 363A00000X · Licence PA6140460 (WA)

Record details

NPI number1770289621
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedFebruary 2, 2023
Last updated in NPPESMay 5, 2026
Certification dateMay 5, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice United Wound Healing Ps — 33 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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