Provider Demographics
NPI:1396513248
Name:KOCHERHANS, JAKE (FDNP)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:KOCHERHANS
Suffix:
Gender:M
Credentials:FDNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5806 W CLOUD LN
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1731
Mailing Address - Country:US
Mailing Address - Phone:801-599-9505
Mailing Address - Fax:
Practice Address - Street 1:5806 W CLOUD LN
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-1731
Practice Address - Country:US
Practice Address - Phone:801-599-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach