Individual
KORDELL ALAN KOEPNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
500 S 8TH ST, BOISE, ID 83702-7107
(855) 255-1750
(855) 255-0905
Mailing address
11504 PAINTBRUSH LN, POCATELLO, ID 83202-5077
(208) 312-7630
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2450
ID
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770289621
—
ID
05
—
2261987
—
WA
05
—
500841624
—
OR
Enumeration date
02/02/2023
Last updated
05/05/2026
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