IndividualActive
Blaze Burkenstock, PA
NPI 1386448728 · Medical Physician Assistant · Mandeville, LA
Provider details
- NPI number
- 1386448728
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- License
- 346049 (LA)
Practice location
2040 N Causeway Blvd
Mandeville, LA 70471-3116
Phone: (985) 727-7676
Mailing address
2040 N Causeway Blvd
Mandeville, LA 70471-3116
Registry dates
- Enumerated
- 2025-04-03
- Last updated
- 2025-04-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.