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NPI Code Detail

MEDICARE: KALISTA LEES

MEDICARE: KALISTA LEES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1710821368
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALISTA LEES
Provider Business Mailing Address
First Line : 1801 WATERMARK DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-7088
Country : US
Telephone Number : 614-487-8758
Fax Number :
Provider Business Practice Location Address
First Line : 59 GRANT ST
Second Line :
City : NEWARK
State : OH
Zip : 43055-3939
Country : US
Telephone Number : 740-349-7511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2026
Last Update Date : 04/15/2026

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Directions to “ KALISTA LEES ” Practice Location

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