Provider Demographics
NPI:1487444949
Name:ACKERLUND, LEXI REANNE (AGNP-C)
Entity type:Individual
Prefix:
First Name:LEXI
Middle Name:REANNE
Last Name:ACKERLUND
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7869
Mailing Address - Street 2:
Mailing Address - City:STAR VALLEY RANCH
Mailing Address - State:WY
Mailing Address - Zip Code:83127
Mailing Address - Country:US
Mailing Address - Phone:307-384-2372
Mailing Address - Fax:
Practice Address - Street 1:50140 S HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5797
Practice Address - Country:US
Practice Address - Phone:307-352-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY50686363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care