# KORDELL ALAN KOEPNICK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1770289621
- **Gender:** Man
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA-2450 | ID | Yes |
| 363A00000X | Physician Assistant | PA219548 | OR | — |
| 363A00000X | Physician Assistant | PA6140460 | WA | — |
| 363AM0700X | Medical Physician Assistant | PA-2450 | ID | — |
| 363AM0700X | Medical Physician Assistant | PA219548 | OR | — |
| 363AM0700X | Medical Physician Assistant | PA61460460 | WA | — |
| 363AS0400X | Surgical Physician Assistant | PA-2450 | ID | — |
| 363AS0400X | Surgical Physician Assistant | PA219548 | OR | — |
| 363AS0400X | Surgical Physician Assistant | PA61460460 | WA | — |

## Other

- **Enumeration date:** 02/02/2023
- **Last updated:** 05/05/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1770289621 | — | ID |
| 05 | — | 2261987 | — | WA |
| 05 | — | 500841624 | — | OR |