Individual
SHASTA M STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-5545
(541) 732-5548
Mailing address
6608 MERCY CT STE B, FAIR OAKS, CA 95628-3171
(916) 241-9844
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95006534
CA
363LA2100X
Acute Care Nurse Practitioner
202010137NP-PP
OR
363LA2100X
Acute Care Nurse Practitioner
55653
WY
363LA2200X
Adult Health Nurse Practitioner
307579
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500786244
—
OR
Enumeration date
12/18/2015
Last updated
07/30/2025
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