# KC BLY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1902198708
- **Gender:** Man
- **Credential:** CNM

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367A00000X | Advanced Practice Midwife | 202107304NP-PP | OR | — |
| 367A00000X | Advanced Practice Midwife | AP61053772 | WA | Yes |

## Other

- **Enumeration date:** 05/11/2011
- **Last updated:** 10/17/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 009003526 | — | CT |
| 05 | — | 500795806 | — | OR |