1356076145 NPI number — MRS. KENDALLYN JOAN BLAY AGACNP-BC, DNP

Table of content: MRS. KENDALLYN JOAN BLAY AGACNP-BC, DNP (NPI 1356076145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356076145 NPI number — MRS. KENDALLYN JOAN BLAY AGACNP-BC, DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAY
Provider First Name:
KENDALLYN
Provider Middle Name:
JOAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AGACNP-BC, DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLAY
Provider Other First Name:
KENDALLYN
Provider Other Middle Name:
JOAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AGACNP-BC, DNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356076145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4120 WINDHAM WOODS CT SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52403-3769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-551-0784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 A AVE NE STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402-5064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-363-3565
Provider Business Practice Location Address Fax Number:
319-363-4001
Provider Enumeration Date:
07/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  H171211 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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