Provider Demographics
NPI:1063039519
Name:JOLY, CASSIE LYNN (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:LYNN
Last Name:JOLY
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 W 2200 RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:KS
Mailing Address - Zip Code:66072-5080
Mailing Address - Country:US
Mailing Address - Phone:913-439-7880
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP-159462363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care