Provider Demographics
NPI:1841160892
Name:FEDORKO, LEXUS R
Entity type:Individual
Prefix:
First Name:LEXUS
Middle Name:R
Last Name:FEDORKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 BIG SKY BLVD APT 103
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-8223
Mailing Address - Country:US
Mailing Address - Phone:740-275-7356
Mailing Address - Fax:
Practice Address - Street 1:3609 PARK EAST DR STE 207
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4309
Practice Address - Country:US
Practice Address - Phone:740-275-7356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPR.CNP.0040630363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner