MEDICARE: LANDON GRIFFIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86342929	MO

General Provider Information

NPI Number	:	1215883699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANDON GRIFFIN

Provider Business Mailing Address
First Line	:	4546 MELLOWLIGHT DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4546 MELLOWLIGHT DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1719
Country	:	US
Telephone Number	:	731-487-1440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2026
Last Update Date	:	03/07/2026

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Directions to “ LANDON GRIFFIN ” Practice Location

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