Organization
WILDSTATE LAWTON LLC
Active
Parent organization
WILDSTATE LAWTON LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WILDSTATE LAWTON LLC
Authorized official
CRYSTAL MICHELLE JOHNSON RN (OWNER)
(580) 280-2558
Entity
Organization
Contact information
Practice address
2504 SW LEE BLVD, LAWTON, OK 73505-8311
(580) 250-1999
Mailing address
2504 SW LEE BLVD, LAWTON, OK 73505-8311
(580) 250-1999
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467327759
DBACOMBINEDHOMEMEDICAL
OK
Enumeration date
10/28/2025
Last updated
11/18/2025
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