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General NPI Number Information
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NPI Number | 1710816962
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Entity Type | Organization
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Legal Business Name | AESTHETIC EXTENSIONS
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 1320 NW HOMESTEAD DR STE E
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City | LAWTON
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State | OK
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Zip | 73505-5243
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Country | US
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Telephone | 804-502-1140
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Fax |
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Provider Business Mailing Address
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Address Line | 3872B SANDOVAL RD
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City | FORT SILL
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State | OK
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Zip | 73503-4606
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Country | US
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Telephone | 804-502-1140
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIANNA JOHNSON
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Credential |
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Telephone | 804-502-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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