Healthcare Provider Details

I. General information

NPI: 1952173130
Provider Name (Legal Business Name): LEXI DOUGHERTY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8381 RIVERWALK PARK BLVD
FORT MYERS FL
33919-8760
US

IV. Provider business mailing address

8381 RIVERWALK PARK BLVD
FORT MYERS FL
33919-8760
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-5425
  • Fax:
Mailing address:
  • Phone: 239-936-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number913046
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number11042488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: