Individual
KC BLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNM
Contact information
Practice address
2525 NE 139TH ST, VANCOUVER, WA 98686-2719
(360) 882-2778
Mailing address
13898 NE 28TH ST, VANCOUVER, WA 98682-8844
(360) 541-2421
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
202107304NP-PP
OR
367A00000X
Advanced Practice Midwife
Primary
AP61053772
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009003526
—
CT
05
—
500795806
—
OR
Enumeration date
05/11/2011
Last updated
10/17/2024
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