Healthcare Provider Details

I. General information

NPI: 1477876415
Provider Name (Legal Business Name): MEGHAN C FLYNN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MEGHAN C BLASE

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12639 OLD TESSON RD SUITE 115
SAINT LOUIS MO
63128-2786
US

IV. Provider business mailing address

12639 OLD TESSON RD SUITE 115
SAINT LOUIS MO
63128-2786
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-0311
  • Fax: 314-849-4423
Mailing address:
  • Phone: 314-849-0311
  • Fax: 314-849-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2010007131
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: