Nicholas Alexander Pukish Jr., PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00845 Issued in MS

Practice address

189 Walmart LN Ste B
Biloxi, MS 39531-4564

Phone

(601) 368-6254

NPI assigned

Jul 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, MS2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicholas.pukish.1@26356.direct.athenahealth.com

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.

• AIDS Healthcare Foundation

  • Clinic/Center
  • Jackson, MS
  • NPI 1255688057
  Medicare reassignment NPD
• AIDS Healthcare Foundation

  • Health Service Clinic/Center
  • North Miami Beach, FL
  • NPI 1427218874
  Medicare reassignment NPD (past)
• AIDS Healthcare Foundation

  • Clinic/Center
  • Orlando, FL
  • NPI 1366914301
  NPD
• AIDS Healthcare Foundation

  • Community/Retail Pharmacy
  • Baton Rouge, LA
  • NPI 1891525184
  NPD

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1073539771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6255 W SUNSET BLVD FL 21",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900287422",
            "telephone_number": "323-860-5200",
            "fax_number": "323-467-7119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 WALMART LN STE B",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395314564",
            "telephone_number": "601-368-6254"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1825 Hurlburt Rd Ste 14",
            "address_purpose": "LOCATION",
            "city": "Fort Walton Beach",
            "state": "FL",
            "postal_code": "325473737",
            "country_code": "US",
            "telephone_number": "850-610-8820",
            "fax_number": "844-297-8690",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4300 Bayou Blvd Ste 17D",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325032671",
            "country_code": "US",
            "telephone_number": "850-476-3131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUKISH",
        "first_name": "NICHOLAS",
        "middle_name": "ALEXANDER",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA 9100880",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MS",
            "license": "PA00845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Psycamore, LLC
• Psychiatry of Texas PLLC
• Psychplus Medical Associates PLLC
• PT Efit LLC
• Briana Diane Pucheu, FNP
• Sreelatha R. Pulakhandam, M.D.
• Nicholas Pulciano, DO
• Pure Smiles Biloxi, Inc.
• Mary Patricia Putnam, FNP
• Quality Health Services, Inc.

• Medical Physician Assistant in Biloxi, MS
• Providers in Biloxi, MS by specialty
• Medical Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; 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.