Healthcare Provider Details

I. General information

NPI: 1972150019
Provider Name (Legal Business Name): KIMBERLY WELCH BLAY DNP, CRNP-PC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 JOHNNYCAKE RD STE 102
WINDSOR MILL MD
21244-2419
US

IV. Provider business mailing address

7001 JOHNNYCAKE RD SUITE 102
ELLICOTT CITY MD
21043
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-5437
  • Fax: 410-744-5436
Mailing address:
  • Phone: 410-744-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR187290
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: