Individual
JESSE JOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1705 E 19TH ST STE 703, TULSA, OK 74104-5418
(918) 382-3178
Mailing address
29514 E 79TH ST S, BROKEN ARROW, OK 74014-5057
(817) 247-3859
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
9125
OK
Other
Enumeration date
03/19/2024
Last updated
08/18/2025
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