Carly Rose Madeen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00771 Issued in MS

Practice address

106 Strange Rd
Starkville, MS 39759-2540

Phone

(601) 910-3004

NPI assigned

Jan 31, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Carly Koenig Former name

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Magnolia Dermatology, PLLCGroup PAC ID 0749576031, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Magnolia Dermatology, PLLC

  • Dermatology Physician
  • Clinton, MS
  • NPI 1841645470
  Medicare reassignment Care Compare group
• Optical 2000

  • Optometrist
  • Clinton, MS
  • NPI 1144422577
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1114780491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 HIGHWAY 80 E",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565252",
            "telephone_number": "601-910-3004",
            "fax_number": "601-910-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 STRANGE RD",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397592540",
            "telephone_number": "601-910-3004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 Highway 80 E",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "MS",
            "postal_code": "390565252",
            "country_code": "US",
            "telephone_number": "601-910-3004",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1659 Lelia Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164818",
            "country_code": "US",
            "telephone_number": "601-910-3004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADEEN",
        "first_name": "CARLY",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-31",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "PA00771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "KOENIG",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Frank W Luke, C.R.N.A.
• Lana Jill Lyle, FNP
• Donna Marie Macklin
• Shareka N Macon, MS
• Melissa Madden, LPC
• Chacketa L Mahmood, MA
• Erin Nicole Mahony, PTA
• Elizabeth Nicole Marquez, LPC
• John Francis Marszalek III, PH.D., LPC
• Martin Oral and Maxillofacial Surgery, PA

• Physician Assistant in Starkville, MS
• Providers in Starkville, MS by specialty
• Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.