Provider Demographics
NPI:1992315899
Name:WAKE, MORGAN BLAKE (PA-C)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:BLAKE
Last Name:WAKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 N BRYANT BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-2861
Mailing Address - Country:US
Mailing Address - Phone:325-747-2271
Mailing Address - Fax:325-747-2275
Practice Address - Street 1:2626 N BRYANT BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-2861
Practice Address - Country:US
Practice Address - Phone:325-747-2271
Practice Address - Fax:325-747-2275
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15111261QU0200X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program