Provider Demographics
NPI:1629798095
Name:KOVACH, JEREMY KENT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:KENT
Last Name:KOVACH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E CENTRAL AVE STE 365
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6597
Mailing Address - Country:US
Mailing Address - Phone:509-435-0973
Mailing Address - Fax:509-435-0978
Practice Address - Street 1:212 E CENTRAL AVE STE 365
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6597
Practice Address - Country:US
Practice Address - Phone:509-435-0973
Practice Address - Fax:509-435-0978
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program