NPI age
3 years
Enumerated 2023-02-02
● Active
Type 1 · Individual
Kordell Alan Koepnick, PA
Koepnick is 1 of 363 physician assistant providers in Boise and 1 of 1263 in Idaho.
Primary specialty
Physician Assistant
Plus 8 subspecialties
Licensed in
ID, WA, OR
3 states
Status
Active
No deactivations on record
Last NPPES update
2026-05-05
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 1263 active physician assistant providers in Idaho.
NPI age
3 years
↓ 6 yr below median (9 yr)
State licenses
3 states
Top 81% — 19% of peers are multi-state
Subspecialties
2
In the 35% of peers with subspecialties
NPI lifetime · 2023 → 2026
2023-02Enumerated in NPPES
2023
2026
Where they practice
Practice location
500 S 8th St
Boise, ID 837027107
Mailing address
11504 Paintbrush Ln
Pocatello, ID 832025077
Additional practice locations
2 secondary locations on file with NPPES.
Location 2
413 29th St Ne Ste I
Puyallup, WA 983727154
Location 3
5200 Meadows Rd Ste 200
Lake Oswego, OR 970350086
Specialties
-
Physician Assistant PrimaryA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally...
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Physician AssistantDefinition to come...
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Physician AssistantDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (WA) | 2261987 | |
| 05 (ID) | 1770289621 | |
| 05 (OR) | 500841624 |
Multi-state credentialing: Licensed in 3 states. Useful context for credentialers building cross-state provider networks.
Practice context
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
Recently enumerated nearby: 3 new physician assistant providers have been added in Boise in the last 180 days.
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Request a quote →How to verify this provider
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.