Active NPI
Jeff P Jolly, PA
- Physician Assistant
- Longview, WA
National Provider Identifier
1841297744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10002542
- Practice address
- 1615 Delaware St
Longview, WA 98632-2310 - Phone
- (360) 414-2360
- Fax
- (360) 414-2361
- NPI assigned
- Jul 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10002542 | WA | Primary |
Addresses
Primary practice location
1615 Delaware St
Longview, WA 98632-2310
Mailing address
PO Box 249
Longview, WA 98632-7154
Phone (360) 414-2000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8908756 | Other | WA | CRIME VICTIMS |
| 134929 | Other | WA | LABOR & IND. |
| 8324048 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841297744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 249",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986327154",
"telephone_number": "360-414-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1615 DELAWARE ST",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986322310",
"telephone_number": "360-414-2360",
"fax_number": "360-414-2361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOLLY",
"first_name": "JEFF",
"middle_name": "P",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10002542",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8908756",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & IND.",
"identifier": "134929",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8324048",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.