Healthcare Provider Details

I. General information

NPI: 1417412032
Provider Name (Legal Business Name): SHAE HORSTING STEPHENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 RIVERSIDE PARK BLVD
MACON GA
31210-1395
US

IV. Provider business mailing address

4660 RIVERSIDE PARK BLVD
MACON GA
31210-1395
US

V. Phone/Fax

Practice location:
  • Phone: 478-474-2114
  • Fax: 478-474-8001
Mailing address:
  • Phone: 478-474-2114
  • Fax: 478-474-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN225449
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: