Individual
JACLYN JOHNSON JOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
775 POLE LINE RD W STE 312, TWIN FALLS, ID 83301-5823
(208) 814-8500
(208) 814-8960
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1520
ID
Other
Enumeration date
06/20/2017
Last updated
06/10/2024
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