MEDICARE: DR. ERIC LANDON NP

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	363L00000X	Nurse Practitioner	1116211	LA
2	363LF0000X	Family Nurse Practitioner	R860220	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881643393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC LANDON NP

Provider Business Mailing Address
First Line	:	PO BOX 6705
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39506-6705
Country	:	US
Telephone Number	:	228-865-1330
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 MAIN ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-5101
Country	:	US
Telephone Number	:	228-762-7451
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	06/17/2011

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