Healthcare Provider Details

I. General information

NPI: 1396513248
Provider Name (Legal Business Name): JAKE KOCHERHANS FDNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5806 W CLOUD LN
HERRIMAN UT
84096-1731
US

IV. Provider business mailing address

5806 W CLOUD LN
HERRIMAN UT
84096-1731
US

V. Phone/Fax

Practice location:
  • Phone: 801-599-9505
  • Fax:
Mailing address:
  • Phone: 801-599-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: