Provider Demographics
NPI:1083677207
Name:PARKER, MELINDA GOULD (CNM, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:GOULD
Last Name:PARKER
Suffix:
Gender:F
Credentials:CNM, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BLECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-7408
Mailing Address - Country:US
Mailing Address - Phone:910-824-4517
Mailing Address - Fax:
Practice Address - Street 1:4325 DICK POND RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6810
Practice Address - Country:US
Practice Address - Phone:910-824-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN20109176B00000X
UT263988-4402176B00000X
SC20109363L00000X, 363LW0102X, 367A00000X, 363LP0808X
NC516367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife