Provider Demographics
NPI:1538138342
Name:PARKS, MELANIE D (DNP, FNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:D
Last Name:PARKS
Suffix:
Gender:F
Credentials:DNP, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 COPPER BEACH CT
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-4155
Mailing Address - Country:US
Mailing Address - Phone:540-241-3572
Mailing Address - Fax:540-381-2441
Practice Address - Street 1:55 COPPER BEACH CT
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4155
Practice Address - Country:US
Practice Address - Phone:540-241-3572
Practice Address - Fax:540-381-2441
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001140002163WP0808X
VA0024165998363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ11634Medicare UPIN