Provider Demographics
NPI:1265044267
Name:CAUGHMAN, ELLEN LEE (DNP, APRN, MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:LEE
Last Name:CAUGHMAN
Suffix:
Gender:F
Credentials:DNP, APRN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 FRIENDSHIP LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-8702
Mailing Address - Country:US
Mailing Address - Phone:843-251-2537
Mailing Address - Fax:
Practice Address - Street 1:82 WHITES CROSSING PLAZA
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472
Practice Address - Country:US
Practice Address - Phone:910-721-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24192363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP7815Medicaid