Provider Demographics
NPI:1689919318
Name:KOCHEVAR, ALEXIS GRANT (PAC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:GRANT
Last Name:KOCHEVAR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S 20TH AVE STE H
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3704
Mailing Address - Country:US
Mailing Address - Phone:303-655-1111
Mailing Address - Fax:303-655-1172
Practice Address - Street 1:70 S 20TH AVE STE H
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3704
Practice Address - Country:US
Practice Address - Phone:303-655-1111
Practice Address - Fax:303-655-1172
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1829363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical