Provider Demographics
NPI:1609475151
Name:STEPHENSON, JILLIAN ROSE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ROSE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 LAKESIDE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5778
Mailing Address - Country:US
Mailing Address - Phone:478-745-9204
Mailing Address - Fax:478-745-9321
Practice Address - Street 1:6060 LAKESIDE COMMONS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5778
Practice Address - Country:US
Practice Address - Phone:478-745-9204
Practice Address - Fax:478-745-9321
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245155363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty