Elizabeth Grace Bufkin, PA-C
Individual provider Active NPI Physician Assistant · Vicksburg, MS
NPI 1235997669 · NPPES record last updated Jan 27, 2025
Key facts
- NPI
- 1235997669
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00753 (MS)
- Practice address
- 2374 Jeff Davis Rd
Vicksburg, MS 39180-9601 - Phone
- (601) 831-3543
- NPI assigned
- Mar 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240626001328 | MS | Practitioner - Physician Assistant | 2365986825 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00753 | MS | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vicksburg Clinic LLC | Current |
Accepting new patients | |
| Vicksburg Clinic LLC | Past | Accepting new patients |
Locations
2100 Highway 61 N
Vicksburg, MS 39183
Phone (601) 883-5001
104 McAuley Dr
Vicksburg, MS 39183
Phone (601) 638-7271
Interoperability endpoints
- grace.bufkin.1@1475.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00753 | MS | Yes |
Addresses
Primary practice location
2374 Jeff Davis Rd
Vicksburg, MS 39180-9601
Mailing address
2100 Highway 61 N
Vicksburg, MS 39183-8211
Phone (601) 883-6030
Other providers in Vicksburg, MS
- Megan Laird Brown
- Minnie Brown
- Sandra Thomas Brown
- Milisia Arnise Bruce
- Annette Bryant
- Kori Screws Bufkin
- Tenecia Bullock
- Jeronica Bunch
- Matthew S Buntyn
- Sandra F. Burford
All providers in Vicksburg, MS · Physician Assistant in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.