MEDICARE: MARY STEPHENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN084904	GA

General Provider Information

NPI Number	:	1316898943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY STEPHENS

Provider Business Mailing Address
First Line	:	102 CREEK BLUFF TRL
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-7639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 CREEK BLUFF TRL
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-7639
Country	:	US
Telephone Number	:	229-331-5027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ MARY STEPHENS ” Practice Location

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