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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20109	SC
2	363L00000X	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	:	1113 44TH AVE N STE 202
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5781
Country	:	US
Telephone Number	:	843-779-8089
Fax Number	:	843-376-9742

Provider Business Practice Location Address
First Line	:	1113 44TH AVE N STE 202
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5781
Country	:	US
Telephone Number	:	843-449-6261
Fax Number	:	843-376-9742

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	04/06/2026

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