Provider Demographics
NPI:1134899388
Name:BLAKESLEY, REBECCA (APRN- PMHNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BLAKESLEY
Suffix:
Gender:F
Credentials:APRN- PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 SOUTHAMPTON RD
Mailing Address - Street 2:STE B #115
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510
Mailing Address - Country:US
Mailing Address - Phone:413-426-8729
Mailing Address - Fax:
Practice Address - Street 1:836 SOUTHAMPTON RD STE B
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1960
Practice Address - Country:US
Practice Address - Phone:602-800-4699
Practice Address - Fax:415-276-5889
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018903363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health