Provider Demographics
NPI:1386811636
Name:ROUSE, KERRI KATHERINE KALIVAS (MD)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:KATHERINE KALIVAS
Last Name:ROUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:KATHERINE
Other - Last Name:KALIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7510 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4502
Mailing Address - Country:US
Mailing Address - Phone:480-941-7229
Mailing Address - Fax:
Practice Address - Street 1:7510 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4502
Practice Address - Country:US
Practice Address - Phone:480-941-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ445052084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program