Wildstate Lawton LLC
NPI 1467327759ActiveOrganization· Clinic/Center· Lawton, OK
Clinic/Center in Lawton, Oklahoma, registered in NPPES in October 2025. The authorized official on file is Crystal Michelle Johnson, RN, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1467327759 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 7, 2025 |
| Last updated in NPPES | Oct 20, 2025 |
| Certified by provider | Oct 20, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Clinic/Center Primary | 261Q00000X | — | — |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (OK) |
|---|
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All 22 Clinic/Center providers in Lawton · All Clinic/Center providers in Oklahoma