Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Roughgarden

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1174077614

Kelly Roughgarden is a Student in an Organized Health Care Education/Training Program in Stockton, California. Registered with an NPI since 2016.

In the registry since
2016

Practice location Address checks out

5405 N Pershing Ave Ste C-1
Stockton, CA 95207-5451
Phone: (209) 476-1959
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1174077614
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 13, 2016
Last updated in NPPESAugust 13, 2016

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