Wildstate Lawton LLC

NPI #1043188261 in Lawton, Oklahoma

Provider Information

NPI Number
1043188261
Entity Type
Organization
Organization Name
Wildstate Lawton LLC
Subpart
Yes (part of a larger organization)
Parent Organization
WILDSTATE LAWTON LLC
Primary Specialty
Durable Medical Equipment & Medical Supplies
Enumeration Date
Oct 28, 2025
Last Updated
Nov 18, 2025

Practice Location

Address
2504 SW LEE BLVD
City
Lawton
ZIP Code
73505-8311
Phone
(580) 250-1999

Authorized Official

Name
CRYSTAL MICHELLE JOHNSON, RN
Title
OWNER
Phone
(580) 280-2558

Specialties & Taxonomy Codes

Specialty
Durable Medical Equipment & Medical Supplies

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