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: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 44TH AVE N STE 202
MYRTLE BEACH SC
29577-5781
US

IV. Provider business mailing address

1113 44TH AVE N STE 202
MYRTLE BEACH SC
29577-5781
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-6261
  • Fax: 843-376-9742
Mailing address:
  • Phone: 843-779-8089
  • Fax: 843-376-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number20109
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20109
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: