MEDICARE: MS. ELLEN LEE CAUGHMAN DNP, APRN, MSN, FNP

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	363LP2300X	Primary Care Nurse Practitioner	24192	SC
2	363LF0000X	Family Nurse Practitioner	24192	SC
3	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	1265044267	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265044267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN LEE CAUGHMAN DNP, APRN, MSN, FNP

Provider Business Mailing Address
First Line	:	5807 FRIENDSHIP LN
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-8702
Country	:	US
Telephone Number	:	843-251-2537
Fax Number	:

Provider Business Practice Location Address
First Line	:	3864 RENEE DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4108
Country	:	US
Telephone Number	:	843-353-2111
Fax Number	:	843-236-0331

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

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	03/29/2025

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