Provider Demographics
NPI:1124232160
Name:KNODEL, KARRI LINN (MPAS, MS, PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:KARRI
Middle Name:LINN
Last Name:KNODEL
Suffix:
Gender:F
Credentials:MPAS, MS, PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:22 CORPORATE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7985
Mailing Address - Country:US
Mailing Address - Phone:949-722-7038
Mailing Address - Fax:949-630-4900
Practice Address - Street 1:22 CORPORATE PLAZA DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7985
Practice Address - Country:US
Practice Address - Phone:949-722-7038
Practice Address - Fax:949-630-4900
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program