Madisyn Creekmore, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-15914 Issued in NC

Practice address

3650 Express Dr
South Brunswick, NC 28470-6501

Phone

(910) 754-2229

NPI assigned

Oct 16, 2025

Last updated

Oct 16, 2025By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Seashore Pediatrics

  • Pediatrics Physician
  • Loris, SC
  • NPI 1265458251
  NPD (past)

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

{
    "created_epoch": "1760572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1225904279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8082 SCARSDALE ST NE UNIT 7",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284510979",
            "telephone_number": "336-909-2725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 EXPRESS DR",
            "city": "SOUTH BRUNSWICK",
            "state": "NC",
            "postal_code": "284706501",
            "telephone_number": "910-754-2229"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1517 N Howe St # 7-8",
            "address_purpose": "LOCATION",
            "city": "Southport",
            "state": "NC",
            "postal_code": "284612772",
            "country_code": "US",
            "telephone_number": "910-454-8877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CREEKMORE",
        "first_name": "MADISYN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-16",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-15914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.