KELLY COSTELLO BLACKMON APRN
NPI 1992110688
Nurse Practitioner in Waycross, GA

Q: What is Kelly Blackmon's NPI number?

The NPI number for Kelly Blackmon is 1992110688. It was assigned to this individual provider in the NPPES registry on June 22, 2014.

Q: What is Kelly Blackmon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Blackmon was last updated on October 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 22, 2014PECOS EnrolledAccepts Medicare Assignment

90.48/100

CMS Quality Rating

1706 ALICE ST, WAYCROSS, GA 31501(912) 285-1140(912) 285-1125 Get Directions Write a Review

NPPES record last updated: October 15, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

On this page

About Kelly Costello Blackmon Aprn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY COSTELLO BLACKMON APRN (NPI 1992110688) is an individual nurse practitioner in Waycross, Georgia, licensed in Georgia (APRN-NP124057) and active in the NPI registry since June 2014. She is enrolled in Medicare PECOS, is affiliated with Memorial Satilla Health, and is a graduate of Other (2014).

NPPES Registry Identity

NPI1992110688

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameKELLY COSTELLO BLACKMONCredential: APRN

Location Address1706 ALICE STWaycross, GA 31501-5216

Mailing AddressPo Box 749495Atlanta, GA 30374-9495 · (855) 963-2100 · Fax (239) 236-2775

Phone(912) 285-1140

Fax(912) 285-1125

Sole ProprietorNo

Medical School CMSOtherGraduated 2014

Enumeration DateJune 22, 2014

Last NPPES UpdateOctober 15, 2025

NPPES CertifiedOctober 15, 2025

✔ NPI 1992110688 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in GA · APRN-NP124057

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License APRN-NP124057 (GA)

1706 ALICE ST, Waycross, GA 31501

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Other Identifiers 1

Medicaid003154267AGA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arkansas Health & Wellness and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Costello Blackmon Aprn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3072830058

PECOS Enrollment IDI20150401001028

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes 99348

An established patient home visit is a 25-minute appointment where a healthcare provider visits you at your home. This service is for patients who have previously been seen by the provider. It includes a check-up and discussion about your health concerns.

63 services42 patients

Residence visit for new patient with high level of medical decision making, per day, if using time, at least 75 minutes 99345

A new patient home visit is a comprehensive 75-minute appointment conducted at your home. The healthcare professional will assess your health, discuss any concerns, and create a personalized care plan. It's convenient, comfortable, and tailored to your specific needs.

59 services59 patients

Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes 99350

An established patient home visit is a service where a healthcare professional visits a patient's home for a check-up or treatment. The visit typically lasts for about an hour. This service is especially beneficial for patients who may have difficulty traveling to a healthcare facility.

51 services27 patients

Residence visit for established patient with straightforward medical decision making, per day, if using time, at least 15 minutes 99347

An established patient home visit is a service where a healthcare professional visits your home for a 15-minute check-up. It's designed for patients who have previously seen the professional. The visit may include basic health assessments and discussions about your ongoing care.

29 services19 patients

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes 99349

An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.

18 services16 patients

Advance care planning, first 30 minutes 99497

Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.

18 services18 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Memorial Satilla Health

Acute Care Hospitals · Waycross, GA

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number110003

Location1900 Tebeau StreetWaycross, GA 31501 · Ware County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 31501 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.23 typical visit price

range $53.31 – $164.04

Typical copayment $20.80 (range $13.32 – $41.01)

Most-billed visit code 99203

Established Patient

$94.84 typical visit price

range $16.68 – $133.24

Typical copayment $23.71 (range $4.17 – $33.31)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

90.48/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored through an Alternative Payment Model

Quality

74.5

Promoting Interoperability

95.74

Improvement Activities

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOSSELYNN ELIZABETH MALLARD PA-C

Physician Assistant (Medical)