Healthcare Provider Details

I. General information

NPI: 1265044267
Provider Name (Legal Business Name): ELLEN LEE CAUGHMAN DNP, APRN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3864 RENEE DR
MYRTLE BEACH SC
29579-4108
US

IV. Provider business mailing address

5807 FRIENDSHIP LN
MYRTLE BEACH SC
29588-8702
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-2111
  • Fax: 843-236-0331
Mailing address:
  • Phone: 843-251-2537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24192
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number24192
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1265044267
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: