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NPI Code Detail

MEDICARE: DR. CAROLINE FRASER JOLLEY MD

MEDICARE: DR. CAROLINE FRASER JOLLEY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician15197AWY

General Provider Information

NPI Number : 1588226088
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROLINE FRASER JOLLEY MD
Provider Business Mailing Address
First Line : PO BOX 1310
Second Line :
City : RIVERTON
State : WY
Zip : 82501-0158
Country : US
Telephone Number : 307-856-9281
Fax Number :
Provider Business Practice Location Address
First Line : 14 GREAT PLAINS RD
Second Line :
City : ARAPAHOE
State : WY
Zip : 82510-9144
Country : US
Telephone Number : 206-320-2484
Fax Number : 306-320-8173
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2019
Last Update Date : 08/14/2023

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