BLAZE BURKENSTOCK PA
NPI 1386448728
Physician Assistant - Medical in Mandeville, LA

Q: What is Blaze Burkenstock's NPI number?

The NPI number for Blaze Burkenstock is 1386448728. It was assigned to this individual provider in the NPPES registry on April 3, 2025.

Q: What is Blaze Burkenstock's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Blaze Burkenstock was last updated on April 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 03, 2025

2040 N CAUSEWAY BLVD, MANDEVILLE, LA 70471(985) 727-7676 Get Directions Write a Review

NPPES record last updated: April 3, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Blaze Burkenstock Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLAZE BURKENSTOCK PA (NPI 1386448728) is an individual medical provider in Mandeville, Louisiana, licensed in Louisiana (346049) and active in the NPI registry since April 2025. He maintains a secondary practice location in New Orleans.

NPPES Registry Identity

NPI1386448728

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameBLAZE BURKENSTOCKCredential: PA

Location Address2040 N CAUSEWAY BLVDMandeville, LA 70471-3116

Mailing Address2040 N Causeway BlvdMandeville, LA 70471-3116

Phone(985) 727-7676

Sole ProprietorNo

Enumeration DateApril 3, 2025

NPPES CertifiedApril 3, 2025

✔ NPI 1386448728 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in LA · 346049

2040 N CAUSEWAY BLVD, Mandeville, LA 70471

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Secondary Practice Location 1

Location 16600 Fleur De Lis DrNew Orleans, LA 70124-1430 · Phone (504) 888-2829

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KELLY G BURKENSTOCK MD A PROFESSIONAL MEDICAL CORPORATION

Internal Medicine

2040 N CAUSEWAY BLVD
MANDEVILLE, LA 70471

St. Tammany Parish (985) 727-7676

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blaze Burkenstock's NPI number?

The NPI number for Blaze Burkenstock is 1386448728. It was assigned to this individual provider in the NPPES registry on April 3, 2025.

Where is Blaze Burkenstock located?

Blaze Burkenstock practices at 2040 N Causeway Blvd, Mandeville, LA 70471. The listed phone number is (985) 727-7676.

What is Blaze Burkenstock's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Blaze Burkenstock was last updated on April 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.