Organization
WILDSTATE LAWTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL MICHELLE JOHNSON RN (OWNER)
(580) 280-2558
Entity
Organization
Contact information
Practice address
2506 SW LEE BLVD, LAWTON, OK 73505-8311
(580) 280-2558
Mailing address
2506 SW LEE BLVD, LAWTON, OK 73505-8311
(580) 280-2558
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
10/07/2025
Last updated
10/20/2025
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