=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760587174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNA JOLLY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 S PROSPECT ST STE 6
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01002-2268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-547-4886
-----------------------------------------------------
Fax | 413-296-9354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 S PROSPECT ST STE 6
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01002-2268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-547-4886
-----------------------------------------------------
Fax | 413-296-9354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 251899
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 251899
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------