Individual
MCKENNA BLYLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 NORTH AVE, BATTLE CREEK, MI 49017-3307
(269) 245-8660
Mailing address
8537 2ND ST, MATTAWAN, MI 49071-9409
(269) 808-8894
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010163
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
MI
Other
Enumeration date
02/10/2020
Last updated
12/27/2022
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