Organization
AESTHETIC EXTENSIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIANNA JOHNSON (OWNER)
(804) 502-1140
Entity
Organization
Contact information
Practice address
1320 NW HOMESTEAD DR STE E, LAWTON, OK 73505-5243
(804) 502-1140
Mailing address
3872B SANDOVAL RD, FORT SILL, OK 73503-4606
(804) 502-1140
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
05/14/2026
Last updated
05/14/2026
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