Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Costello Blackmon, APRN

Individual provider Acute Care Nurse Practitioner · NPI 1992110688

Kelly Costello Blackmon, APRN is a Nurse Practitioner in Waycross, Georgia. Qualified in 2014, 12 years ago. Practices with American Oncology Partners PA, a 383-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
12
Licensed in
GA
In the registry since
2014
Specialties on file
2
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.

See every abbreviation used in this directory →

Practice location Address checks out

1706 Alice St
Waycross, GA 31501-5216
Phone: (912) 285-1140
Fax: (912) 285-1125
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2409 N. Patterson Street, Valdosta, GA 31602-2512 — (229) 259-4369

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence APRN-NP124057 (GA)
Acute Care Nurse Practitioner Taxonomy 363LA2100X · Licence APRN-NP124057 (GA)

Record details

NPI number1992110688
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRN
Sole proprietorNo
NPI enumeratedJune 22, 2014
Last updated in NPPESOctober 15, 2025
Certification dateOctober 15, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice American Oncology Partners Pa — 383 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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