Healthcare Provider Details

I. General information

NPI: 1740297449
Provider Name (Legal Business Name): ROSEANNE KELTON COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 E CALLE DEL MEDIO
PHOENIX AZ
85018-4442
US

IV. Provider business mailing address

5121 E CALLE DEL MEDIO
PHOENIX AZ
85018-4442
US

V. Phone/Fax

Practice location:
  • Phone: 602-616-5339
  • Fax:
Mailing address:
  • Phone: 602-616-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20751
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: