Individual
KELLY JOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 7TH AVE S, BIRMINGHAM, AL 35233-1711
(205) 249-4542
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-100459
AL
363LP0200X
Pediatric Nurse Practitioner
Primary
1-100459
AL
Other
Enumeration date
04/10/2023
Last updated
02/26/2025
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