Healthcare Provider Details

I. General information

NPI: 1083677207
Provider Name (Legal Business Name): MELINDA GOULD PARKER CNM, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 DICK POND RD
MYRTLE BEACH SC
29588-6810
US

IV. Provider business mailing address

113 BLECKLEY AVE
MYRTLE BEACH SC
29579-7408
US

V. Phone/Fax

Practice location:
  • Phone: 910-824-4517
  • Fax:
Mailing address:
  • Phone: 910-824-4517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPRN20109
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number263988-4402
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20109
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number20109
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number516
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number20109
License Number StateSC
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number20109
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: