Provider Demographics
NPI:1225601529
Name:RUSSELL, LEXI (PA-C)
Entity type:Individual
Prefix:
First Name:LEXI
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:LEXI
Other - Middle Name:RACQUEL
Other - Last Name:TOPHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10433 S REDWOOD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8502
Mailing Address - Country:US
Mailing Address - Phone:801-260-1919
Mailing Address - Fax:801-260-1441
Practice Address - Street 1:476 N 900 W STE C
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-5202
Practice Address - Country:US
Practice Address - Phone:801-492-1611
Practice Address - Fax:801-492-1480
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13023102-1206363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant