Provider Demographics
NPI:1093107617
Name:KOCHEVAR, JENNA (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:KOCHEVAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:BORYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:253-459-8231
Mailing Address - Fax:
Practice Address - Street 1:910 W 5TH AVE STE 800
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2912
Practice Address - Country:US
Practice Address - Phone:509-755-5120
Practice Address - Fax:509-755-6580
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0135322086S0102X
WAOP611996822086S0102X, 208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program