Healthcare Provider Details

I. General information

NPI: 1205585874
Provider Name (Legal Business Name): BLAKE DANIEL KOCEJA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 HEALTH CARE DR
ROCK HILL SC
29732-3858
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-706-7446
  • Fax:
Mailing address:
  • Phone: 980-302-7015
  • Fax: 980-302-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27865
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5016262
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: