| Doctor Name: | MARY SULLIVAN JOLLY |
| NPI Number: | 1093056038 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN, FNP-BC |
| License Number: | 3007943 |
| Business Practice Address: | 250 Main Street, Suite E Cadiz, KY - 42211 |
| Business Phone Number: | 2705226963 |
| Business Fax Number: | 2705227231 |
| Mailing Address: | Po Box 2140, CADIZ |
| State: | KY |
| Postal Code: | 422112140 |
| Phone Number: | 2705226963 |
| Fax Number: | 2705227231 |
| NPI Enumeration Date: | 03/14/2013 |
| NPI Last Update Date: | 05/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 3007943 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |