Provider Demographics
NPI:1194755082
Name:JOLLY, JANET M (CFNP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:JOLLY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DEPT OF MEDICINE DIVISION OF RHEUMATOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5540
Mailing Address - Fax:601-984-5535
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DIVISION OF RHEUMATOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5540
Practice Address - Fax:601-984-5535
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR858122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00578202Medicaid
AL178989Medicaid
MS378474YS8TMedicare PIN
AL178989Medicaid
MS302I508831Medicare PIN
MSP01435473Medicare PIN