Makenna Bourland, PA-C
Individual provider Active NPI Physician Assistant · Tupelo, MS
NPI 1659123784 · NPPES record last updated Mar 11, 2026
Key facts
- NPI
- 1659123784
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00927 (MS)
- Practice address
- 830 S Gloster St
Tupelo, MS 38801-4996 - Phone
- (662) 377-3000
- NPI assigned
- Apr 2, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Relias Emergency Medicine Specialists of Tupelo LLC
Practice addresses (Care Compare)
830 S Gloster St
Tupelo, MS 38801-4934
Phone (662) 377-3000
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 |
|---|---|---|---|---|
| I20260402000699 | MS | Practitioner - Physician Assistant | 6406331990 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00927 | MS | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00927 | MS | Yes |
| 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
Other providers in Tupelo, MS
- Katelyn C Boren
- Samantha Grace Boren
- Sharon Dugas Boudreaux
- Charles Edward Bouldin
- Keisha Bounds
- Kevin Boutin
- Ronondo Jerome Bowen
- Shirley Jean Bowers
- Brittany Rachael Box
- Martha Leanne Box
All providers in Tupelo, 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 Mar 11, 2026. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.