Provider Demographics
NPI:1629942388
Name:BLAKENEY FAMILY PRACTICE, PLLC
Entity type:Organization
Organization Name:BLAKENEY FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKENEY-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:980-402-4668
Mailing Address - Street 1:PO BOX 37054
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0517
Mailing Address - Country:US
Mailing Address - Phone:980-402-4668
Mailing Address - Fax:
Practice Address - Street 1:4401 E INDEPENDENCE BLVD STE 208F
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7485
Practice Address - Country:US
Practice Address - Phone:980-402-4668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251J00000XAgenciesNursing Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)