Provider Demographics
NPI:1760366884
Name:OPTIMAL HEALTH AND WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:OPTIMAL HEALTH AND WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:623-640-4973
Mailing Address - Street 1:700 N ESTRELLA PARKWAY STE #145
Mailing Address - Street 2:SUITE 145
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9329
Mailing Address - Country:US
Mailing Address - Phone:602-678-4625
Mailing Address - Fax:855-845-9287
Practice Address - Street 1:700 N ESTRELLA PARKWAY STE #145
Practice Address - Street 2:SUITE 145
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9329
Practice Address - Country:US
Practice Address - Phone:602-678-4625
Practice Address - Fax:855-845-9287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty