Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10170 | MT |
NPI | 1003846577 |
---|---|
Provider Name | Heather D Kjerstad |
First Address | Belgrade, MT 59714-7909 |
Second Address | Belgrade, MT 59714-7909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 30/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000091505 | BCBS (01) | MT |
1003846577 | (05) | MT |
H68212 | (02) |