Healthcare Provider Details

I. General information

NPI: 1356076145
Provider Name (Legal Business Name): KENDALLYN JOAN BLAY AGACNP-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDALLYN JOAN BLAY AGACNP-BC, DNP

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 A AVE NE STE 400
CEDAR RAPIDS IA
52402-5064
US

IV. Provider business mailing address

4120 WINDHAM WOODS CT SE
CEDAR RAPIDS IA
52403-3769
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-3565
  • Fax: 319-363-4001
Mailing address:
  • Phone: 319-551-0784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberH171211
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: