Kelly Costello Blackmon, APRN - Medicare Nurse Practitioner in Waycross, GA

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Kelly Costello Blackmon, APRN is a medicare enrolled "Nurse Practitioner" in Waycross, Georgia. Her current practice location is 1706 Alice St, Waycross, Georgia. You can reach out to her office (for appointments etc.) via phone at (912) 285-1140.

Kelly Costello Blackmon is licensed to practice in Georgia (license number APRN-NP124057) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1992110688.

Contact Information

Kelly Costello Blackmon, APRN
1706 Alice St,
Waycross, GA 31501-5216
(912) 285-1140
(912) 285-1125

Map and Direction




Provider's Profile

Full NameKelly Costello Blackmon
GenderFemale
SpecialityNurse Practitioner
Location1706 Alice St, Waycross, Georgia
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1992110688
  • Provider Enumeration Date: 06/22/2014
  • Last Update Date: 10/15/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 3072830058
  • Enrollment ID: I20150401001028

Medical Identifiers

Medical identifiers for Kelly Costello Blackmon such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1992110688NPI-NPPES
003154267AMedicaidGA

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LA2100XNurse Practitioner - Acute Care APRN-NP124057 (Georgia)Secondary
363L00000XNurse Practitioner APRN-NP124057 (Georgia)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kelly Costello Blackmon allows following entities to bill medicare on her behalf.
Entity NameHospital Authority Of Valdosta And Lowndes County Georgia
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1033160791
PECOS PAC ID: 1355334509
Enrollment ID: O20040405001313
Entity NameBethany Hospice And Palliative Care, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1972709160
PECOS PAC ID: 1052409414
Enrollment ID: O20170428001358
Entity NameAmerican Oncology Partners Pa
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1265929723
PECOS PAC ID: 0042569758
Enrollment ID: O20200615003208
Entity NameSgmc Physician Network Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1417597170
PECOS PAC ID: 4082036843
Enrollment ID: O20201015000629

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Costello Blackmon is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Kelly Costello Blackmon, APRN
Po Box 749495,
Atlanta, GA 30374-9495

Ph: (855) 963-2100		Kelly Costello Blackmon, APRN
1706 Alice St,
Waycross, GA 31501-5216

Ph: (912) 285-1140

Reviews and Comments


Nurse Practitioner Nurses in Waycross, GA

Barbara D Pittman, FNP-C
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 615a Pendleton St, Waycross, GA 31501
Phone: 912-548-0710    Fax: 912-548-0071
Robert Scott Jacobs, NP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 403a Lister St, Waycross, GA 31501
Phone: 912-283-4422    Fax: 912-283-4866
Mrs. Dana Marie Morgan, FNP-BC, PMHNP-BC
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 1610 Alice St, Waycross, GA 31501
Phone: 912-584-3263    Fax: 912-809-2296
Mr. James Aaron Houser, FNP-C
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 1206 Alice St, Waycross, GA 31501
Phone: 912-285-1140    Fax: 912-285-1125
Dawn Lynn Driggers, FNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 1710 1/2 Alice St, Waycross, GA 31501
Phone: 912-614-3768    
Kala Hodges, FNP-C
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 409 Uvalda St, Waycross, GA 31501
Phone: 229-391-3500    
Ms. Andrea M Deloach, FNP-C
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 711 Knight Ave, Waycross, GA 31501
Phone: 912-283-9423    Fax: 912-283-2946

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.