Healthcare Provider Details

I. General information

NPI: 1407771751
Provider Name (Legal Business Name): XIA JOHNSON APSS, CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 W MAIN ST
LEXINGTON KY
40508-2020
US

IV. Provider business mailing address

430 OHIO ST
LEXINGTON KY
40508-1531
US

V. Phone/Fax

Practice location:
  • Phone: 859-285-4768
  • Fax:
Mailing address:
  • Phone: 859-285-4768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: