Provider Demographics
NPI:1174865216
Name:KOHRING, JESSICA M (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:KOHRING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 E SINTO AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2280
Mailing Address - Country:US
Mailing Address - Phone:509-928-4334
Mailing Address - Fax:
Practice Address - Street 1:12410 EAST SINTO SUITE 201
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99216-1200
Practice Address - Country:US
Practice Address - Phone:509-928-4334
Practice Address - Fax:509-928-4335
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60944601207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1174865216Medicaid