Active NPI
Makenna Bourland, PA-C
- Physician Assistant
- Tupelo, MS
National Provider Identifier
1659123784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00927
- Practice address
- 830 S Gloster St
Tupelo, MS 38801-4996 - Phone
- (662) 377-3000
- NPI assigned
- Apr 2, 2024
- Last updated
- Mar 11, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00927 | MS | Primary |
| Medical Physician Assistant | 363AM0700X |
Addresses
Primary practice location
830 S Gloster St
Tupelo, MS 38801-4996
Mailing address
201 W Main St
Tupelo, MS 38804-3917
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
830 S Gloster St
Tupelo, MS 38801-4934
Phone (662) 377-3000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00927 | MS | MD | Physician Assistant |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Tupelo, MS
- NPI 1841664661
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773187200000",
"number": "1659123784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 W MAIN ST",
"city": "TUPELO",
"state": "MS",
"postal_code": "388043917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 S GLOSTER ST",
"city": "TUPELO",
"state": "MS",
"postal_code": "388014996",
"telephone_number": "662-377-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURLAND",
"first_name": "MAKENNA",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-02",
"last_updated": "2026-03-11",
"certification_date": "2026-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MS",
"license": "PA00927",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tupelo, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.