Basic Information
| Provider Information | |||||||||
| NPI: | 1174865216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOHRING | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12410 E SINTO AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992162280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099284334 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12410 EAST SINTO SUITE 201 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992161200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099284334 | ||||||||
| FaxNumber: | 5099284335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2013 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD60944601 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | MD60944601 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1174865216 | 05 | WA | MEDICAID |