Kelly Lynn Jolly, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

30753 Issued in TX

Practice address

405 SE Access Rd Ste a
Iowa Park, TX 76367-6985

Phone

(940) 592-2731

Fax

(940) 592-2739

NPI assigned

Feb 19, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1760015630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5105 LAKE WELLINGTON PKWY",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763101771",
            "telephone_number": "940-636-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 SE ACCESS RD STE A",
            "city": "IOWA PARK",
            "state": "TX",
            "postal_code": "763676985",
            "telephone_number": "940-592-2731",
            "fax_number": "940-592-2739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLY",
        "first_name": "KELLY",
        "middle_name": "LYNN",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-19",
        "last_updated": "2023-11-27",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "30753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.jolly@electrahospital.com",
            "affiliation": "Y",
            "endpointDescription": "work email",
            "affiliationName": "Electra Hospital District",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "405 SE Access Rd Ste A",
            "city": "Iowa Park",
            "state": "TX",
            "country_code": "US",
            "postal_code": "763676985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brie Heaton, PNP
• Raven K Henry, FNP-C
• Iowa Park Consolidated I.S.D
• Iowa Park Physical Therapy
• JKDB Enterprises LLC
• Sheena Kaufman
• Cynthia Ann Lee, LBSW-IPR
• Amanda Michele Meyer, NP
• Navauda Sharee Miller, LPC
• Karen J. Moriarty, DNP, FNP

• All providers in Iowa Park, TX
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.