| Doctor Name: | DR. SUSAN LYNN JOLLY |
| NPI Number: | 1598750366 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 29220 |
| Business Practice Address: | 1210 N. Kentucky West Plains, MO - 65775 |
| Business Phone Number: | 4172561745 |
| Business Fax Number: | 4172561746 |
| Mailing Address: | 1210 N. Kentucky, WEST PLAINS |
| State: | MO |
| Postal Code: | 65775 |
| Phone Number: | 4172561745 |
| Fax Number: | 4172561746 |
| NPI Enumeration Date: | 09/16/2005 |
| NPI Last Update Date: | 02/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 29220 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |