WILDSTATE LAWTON LLC
NPI 1467327759
Clinic/Center in Lawton, OK
About Wildstate Lawton Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WILDSTATE LAWTON LLC (NPI 1467327759) is a healthcare organization registered as a clinic/center in Lawton, Oklahoma and active in the NPI registry since October 2025. The organization maintains a secondary practice location in Lawton and lists Crystal Michelle Johnson, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Wildstate Lawton Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Wildstate Lawton LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Wildstate Lawton LLC's NPI number?
The NPI number for Wildstate Lawton LLC is 1467327759. It was assigned to this organization in the NPPES registry on October 7, 2025.
Where is Wildstate Lawton LLC located?
Wildstate Lawton LLC is located at 2506 SW Lee Blvd, Lawton, OK 73505. The listed phone number is (580) 280-2558.
What is Wildstate Lawton LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Wildstate Lawton LLC enrolled in Medicare?
Yes. Wildstate Lawton LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Wildstate Lawton LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Wildstate Lawton LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Wildstate Lawton LLC accept?
Health plans from Blue Cross and Blue Shield of Oklahoma list Wildstate Lawton LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Wildstate Lawton LLC was last updated on October 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Wildstate Lawton Llc · NPI 1467327759
Clinic/Center organization in Lawton, Oklahoma. Organization record, active in the CMS NPPES registry since October 7, 2025.
## Identity
- **NPI:** 1467327759 (Entity type: Organization)
- **Enumerated:** October 7, 2025
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Organization subpart:** No
- **Authorized official:** Crystal Johnson, OWNER
## Practice location
- **Address:** 2506 SW LEE BLVD, Lawton, OK 73505-8311
- **Phone:** (580) 280-2558
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 20, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1467327759) · Data from the CMS NPPES public registry.