Provider Demographics
NPI:1669468724
Name:FEIEREISEL, KIRSTEN BRANTLEY (MD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:BRANTLEY
Last Name:FEIEREISEL
Suffix:
Gender:
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2011
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-9800
Practice Address - Fax:336-713-9681
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ0085HMedicaid
NC89137EPMedicaid
D5620OtherMEDCOST
WV3810000594Medicaid
7317722OtherAETNA
VA10095654Medicaid
804502OtherPARTNERS
137EPOtherBCBS
P00159774Medicare PIN
804502OtherPARTNERS
D5620OtherMEDCOST