Blaze Burkenstock, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

346049 Issued in LA

Practice address

2040 N Causeway Blvd
Mandeville, LA 70471-3116

Phone

(985) 727-7676

NPI assigned

Apr 3, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kelly G Burkenstock MD a Professional Medical Corporation

  • Internal Medicine Physician
  • Mandeville, LA
  • NPI 1639328578
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1386448728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 N CAUSEWAY BLVD",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 N CAUSEWAY BLVD",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713116",
            "telephone_number": "985-727-7676"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6600 Fleur De Lis Dr",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701241430",
            "country_code": "US",
            "telephone_number": "504-888-2829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURKENSTOCK",
        "first_name": "BLAZE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-03",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "346049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vincent Bui, PHARMD
• Buisson Rnfa, LLC
• Lynsey Buisson, RN, RNFA, CNOR
• Tova Buller
• Joan E Burga, PT
• Michele Burmaster, CRT
• Lonzetta Burris
• Barbara Bates Busby, RPH
• Elizabeth Price Butler, PHARMD
• Callie Smith Byars, CPSS

• Medical Physician Assistant in Mandeville, LA
• Providers in Mandeville, LA by specialty
• Medical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.