Individual
DR. SUSAN LYNN JOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 N KENTUCKY AVE, WEST PLAINS, MO 65775-2029
(417) 256-9111
(417) 256-1746
Mailing address
1210 N. KENTUCKY, WEST PLAINS, MO 65775
(417) 256-1745
(417) 256-1746
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
29220
CO
207X00000X
Orthopaedic Surgery Physician
Primary
2015013479
MO
207X00000X
Orthopaedic Surgery Physician
29220
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01292200
—
CO
01
—
2015013479
MISSOURI MEDICAL LICENSE
MO
01
—
29220
LICENSE
CO
Enumeration date
09/16/2005
Last updated
07/17/2024
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