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General NPI Number Information
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NPI Number | 1225904279
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Entity Type | Individual
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Provider Name | MADISYN CREEKMORE PA
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Gender | Female
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Dates
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Enumeration Date | 10/16/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 3650 EXPRESS DR
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City | SOUTH BRUNSWICK
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State | NC
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Zip | 28470-6501
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Country | US
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Telephone | 910-754-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 8082 SCARSDALE ST NE UNIT 7
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City | LELAND
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State | NC
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Zip | 28451-0979
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Country | US
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Telephone | 336-909-2725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-15914
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License Number State | NC
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