KELLY COSTELLO BLACKMON

WAYCROSS, GA
NPI1992110688
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: GA  RN124057)
Additional Taxonomies363LA2100X Nurse Practitioner, Acute Care
(Licence: GA  RN124057)
Enumeration Date2014-06-22
Last Update Date2025-01-03
Business Address
KELLY COSTELLO BLACKMON APRN
1706 ALICE ST
WAYCROSS, GA 31501-5216
Phone number: 912-285-1140
Mailing Address
KELLY COSTELLO BLACKMON APRN
PO BOX 749495
ATLANTA, GA 30374-9495
Phone number: 855-963-2100