Provider Demographics
NPI:1003846577
Name:KJERSTAD, HEATHER D (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:KJERSTAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:ATTN PFS CREDENTIALING
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7909
Mailing Address - Country:US
Mailing Address - Phone:406-414-3334
Mailing Address - Fax:
Practice Address - Street 1:206 ALASKA FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7909
Practice Address - Country:US
Practice Address - Phone:406-414-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1003846577Medicaid
MT000091505OtherBCBS