Healthcare Provider Details

I. General information

NPI: 1164523197
Provider Name (Legal Business Name): LESLEY HUFFMAN-DILG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLEY HUFFMAN

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 226A
SAINT LOUIS MO
63131-2337
US

IV. Provider business mailing address

660 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8512
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-5900
  • Fax: 314-996-5910
Mailing address:
  • Phone: 314-448-3791
  • Fax: 314-996-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2005004539
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2005004539
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: