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General NPI Number Information
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NPI Number | 1760366884
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH AND WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 700 N ESTRELLA PARKWAY STE #145 SUITE 145
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City | GOODYEAR
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State | AZ
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Zip | 85338-9329
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Country | US
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Telephone | 602-678-4625
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Fax | 855-845-9287
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Provider Business Mailing Address
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Address Line | 700 N ESTRELLA PARKWAY STE #145 SUITE 145
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City | GOODYEAR
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State | AZ
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Zip | 85338-9329
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Country | US
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Telephone | 602-678-4625
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Fax | 855-845-9287
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Authorized Official
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Title or Position | OWNER - PHYSICIAN ASSISTANT
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Name | KERRY KNIGHT
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Credential | PA-C
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Telephone | 623-640-4973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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