Healthcare Provider Details

I. General information

NPI: 1386811636
Provider Name (Legal Business Name): KERRI KATHERINE KALIVAS ROUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRI KATHERINE KALIVAS MD

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 E 1ST ST
SCOTTSDALE AZ
85251-4502
US

IV. Provider business mailing address

7510 E 1ST ST
SCOTTSDALE AZ
85251-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-7229
  • Fax:
Mailing address:
  • Phone: 480-941-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44505
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: