Healthcare Provider Details

I. General information

NPI: 1043175615
Provider Name (Legal Business Name): JESSICA BLECHLE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12812 TESSON FERRY RD
SAINT LOUIS MO
63128-2913
US

IV. Provider business mailing address

12812 TESSON FERRY RD
SAINT LOUIS MO
63128-2913
US

V. Phone/Fax

Practice location:
  • Phone: 314-970-1040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: