Healthcare Provider Details

I. General information

NPI: 1508433608
Provider Name (Legal Business Name): BETH SUE JAEGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 VAUX HALL AVE
MURRELLS INLET SC
29576-6249
US

IV. Provider business mailing address

381 VAUX HALL AVE
MURRELLS INLET SC
29576-6249
US

V. Phone/Fax

Practice location:
  • Phone: 608-556-8030
  • Fax:
Mailing address:
  • Phone: 608-556-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25034
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: