MEDICARE: MELINDA GOULD PARKER CNM, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	APRN20109	SC
2	176B00000X	Midwife	263988-4402	UT
3	363L00000X	Nurse Practitioner	20109	SC
4	363LW0102X	Women's Health Nurse Practitioner	20109	SC
5	367A00000X	Advanced Practice Midwife	516	NC
6	367A00000X	Advanced Practice Midwife	20109	SC
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20109	SC

General Provider Information

NPI Number	:	1083677207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA GOULD PARKER CNM, PMHNP-BC

Provider Business Mailing Address
First Line	:	113 BLECKLEY AVE
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7408
Country	:	US
Telephone Number	:	910-824-4517
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 DICK POND RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6810
Country	:	US
Telephone Number	:	910-824-4517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/30/2021

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