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General NPI Number Information
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NPI Number | 1629942388
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Entity Type | Organization
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Legal Business Name | BLAKENEY FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 4401 E INDEPENDENCE BLVD STE 208F
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City | CHARLOTTE
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State | NC
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Zip | 28205-7485
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Country | US
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Telephone | 980-402-4668
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37054
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City | ROCK HILL
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State | SC
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Zip | 29732-0517
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Country | US
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Telephone | 980-402-4668
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Fax |
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Authorized Official
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Title or Position | CNO
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Name | NIKITA BLAKENEY-WILLIAMS
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Credential | FNP-C
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Telephone | 980-402-4668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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