Provider Demographics
NPI:1790972792
Name:VAUGHAN, BLAKE RENEE (DNP-PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:RENEE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:DNP-PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 EAST AVENUE I
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1916
Mailing Address - Country:US
Mailing Address - Phone:661-522-6770
Mailing Address - Fax:661-723-9079
Practice Address - Street 1:415 EAST AVENUE I
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1916
Practice Address - Country:US
Practice Address - Phone:661-878-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014515363LP0808X
CARN397019163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse