Individual
MRS. MAKENNA BOURLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
830 S GLOSTER ST, TUPELO, MS 38801-4996
(662) 377-3000
Mailing address
201 W MAIN ST, TUPELO, MS 38804-3917
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00927
MS
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
04/02/2024
Last updated
03/11/2026
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