KELLY COSTELLO BLACKMON APRN
NPI 1992110688
Nurse Practitioner in Waycross, GA
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 maintains a secondary practice location in Valdosta.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
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.
Medicare Billing Reassignments
2Medicare enrollment records show Kelly Blackmon reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Lakeland, GA 31635
- Reassigned Medicare billing, Georgia enrollment
- 112 clinicians in this Medicare group
Columbus, OH 43219
- Reassigned Medicare billing, Georgia enrollment
- 49 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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, GAPhysician 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.
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.
Other Providers at the Same Location NPPES 8
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
WAYCROSS, GA 31501
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
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.
Where is Kelly Blackmon located?
Kelly Blackmon practices at 1706 Alice St, Waycross, GA 31501. The listed phone number is (912) 285-1140.
What is Kelly Blackmon's specialty?
The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.
Is Kelly Blackmon enrolled in Medicare?
Yes. Kelly Blackmon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Kelly Blackmon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Blackmon reassigns Medicare benefits to 2 organizations: Hospital Authority Of Valdosta And Lowndes County, Georgia (Lakeland, GA) and American Oncology Partners PA (Columbus, OH). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Blackmon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kelly Blackmon accept?
Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 6 other insurers list Kelly Blackmon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Kelly Blackmon affiliated with any hospitals?
According to CMS data, Kelly Blackmon is affiliated with Memorial Satilla Health.
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 12 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.
# Kelly Costello Blackmon, APRN · NPI 1992110688
Nurse Practitioner physician in Waycross, Georgia. Individual provider, active in the CMS NPPES registry since June 22, 2014.
## Identity
- **NPI:** 1992110688 (Entity type: Individual)
- **Enumerated:** June 22, 2014
- **Primary specialty:** Nurse Practitioner · taxonomy 363L00000X
- **State license:** APRN-NP124057 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 1706 ALICE ST, Waycross, GA 31501-5216
- **Phone:** (912) 285-1140 · **Fax:** (912) 285-1125
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Hospital Authority Of Valdosta And Lowndes County, Georgia (NPI 1518382217, Lakeland, GA); American Oncology Partners PA (NPI 1265929723, Columbus, OH) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2014
## Record status
- **NPPES last updated:** October 15, 2025
- **Other identifiers:** Medicaid 003154267A (GA)
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Source: [NPI Profile](https://npiprofile.com/npi/1992110688) · Data from the CMS NPPES public registry.