Provider Demographics
NPI:1982886586
Name:HUGHES, KALISTA J (MD)
Entity type:Individual
Prefix:
First Name:KALISTA
Middle Name:J
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KALISTA
Other - Middle Name:
Other - Last Name:HUGHES-HESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3615 E JOHN ROWAN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-3264
Mailing Address - Country:US
Mailing Address - Phone:502-348-5968
Mailing Address - Fax:270-706-5802
Practice Address - Street 1:3615 E JOHN ROWAN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-3264
Practice Address - Country:US
Practice Address - Phone:502-348-5968
Practice Address - Fax:270-706-5802
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44882207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100200760Medicaid