Provider Demographics
NPI:1356076145
Name:BLAY, KENDALLYN JOAN (AGACNP-BC, DNP)
Entity Type:Individual
Prefix:MRS
First Name:KENDALLYN
Middle Name:JOAN
Last Name:BLAY
Suffix:
Gender:F
Credentials:AGACNP-BC, DNP
Other - Prefix:DR
Other - First Name:KENDALLYN
Other - Middle Name:JOAN
Other - Last Name:BLAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGACNP-BC, DNP
Mailing Address - Street 1:4120 WINDHAM WOODS CT SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-3769
Mailing Address - Country:US
Mailing Address - Phone:319-551-0784
Mailing Address - Fax:
Practice Address - Street 1:855 A AVE NE STE 400
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5064
Practice Address - Country:US
Practice Address - Phone:319-363-3565
Practice Address - Fax:319-363-4001
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH171211363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care