Provider Demographics
NPI:1265785174
Name:KIERSTEAD, HEATHER MARIE (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:KIERSTEAD
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:FERREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:784 HERCULES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8049
Mailing Address - Country:US
Mailing Address - Phone:802-448-9787
Mailing Address - Fax:802-448-9787
Practice Address - Street 1:6 HIGH ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3001
Practice Address - Country:US
Practice Address - Phone:866-476-1321
Practice Address - Fax:802-257-4342
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH078857-23367A00000X
VT101.0098996367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT101.0098996OtherSTATE LICENSE - APRN
VT1022913Medicaid
NH3094482Medicaid
NH078857-23OtherSTATE LICENSE - APRN