Healthcare Provider Details

I. General information

NPI: 1760366884
Provider Name (Legal Business Name): OPTIMAL HEALTH AND WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N ESTRELLA PARKWAY STE #145 SUITE 145
GOODYEAR AZ
85338-9329
US

IV. Provider business mailing address

700 N ESTRELLA PARKWAY STE #145 SUITE 145
GOODYEAR AZ
85338-9329
US

V. Phone/Fax

Practice location:
  • Phone: 602-678-4625
  • Fax: 855-845-9287
Mailing address:
  • Phone: 602-678-4625
  • Fax: 855-845-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KERRY KNIGHT
Title or Position: OWNER - PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 623-640-4973