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KELLY ROUGHGARDEN
NPI 1174077614
Student in an Organized Health Care Education/Training Program in Stockton, CA

Active since August 13, 2016
5405 N PERSHING AVE, STE. C-1, STOCKTON, CA 95207(209) 476-1959 Get Directions Write a Review

NPPES record last updated: August 13, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Kelly Roughgarden NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY ROUGHGARDEN (NPI 1174077614) is an individual student in an organized health care education/training program in Stockton, California and active in the NPI registry since August 2016.

NPPES Registry Identity

NPI1174077614
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameKELLY ROUGHGARDEN
Location Address5405 N PERSHING AVE, STE. C-1Stockton, CA 95207-5451
Mailing Address3601 Pacific AveStockton, CA 95211-0110
Phone(209) 476-1959
Sole ProprietorNo
Enumeration DateAugust 13, 2016
✔ NPI 1174077614 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
5405 N PERSHING AVE, Stockton, CA 95207
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Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHAEL TABANGCURA
Peer Specialist
5405 N PERSHING AVE, SUITE C1
STOCKTON, CA 95207
San Joaquin County (209) 476-1959
OCTAVIA IVY
Student in an Organized Health Care Education/Training Program
5405 N PERSHING AVE, C 1
STOCKTON, CA 95207
San Joaquin County (209) 476-1959
MERRITT SCHENK
Student in an Organized Health Care Education/Training Program
5405 N PERSHING AVE, SUITE C1
STOCKTON, CA 95207
San Joaquin County (209) 476-1959
MICHAEL FLORES I
Student in an Organized Health Care Education/Training Program
5405 N PERSHING AVE, SUITE C1
STOCKTON, CA 95207
San Joaquin County (209) 476-1959
SONAL SHARMA B.A.
Student in an Organized Health Care Education/Training Program
5405 N PERSHING AVE, STE. C-1
STOCKTON, CA 95207
San Joaquin County (209) 476-1959
CATHERINE MARIE PEREZ
Student in an Organized Health Care Education/Training Program
5405 N PERSHING AVE, STE. C-1
STOCKTON, CA 95207
San Joaquin County (209) 476-1959
KRISTY FOJO
Student in an Organized Health Care Education/Training Program
5405 N PERSHING AVE, STE. C-1
STOCKTON, CA 95207
San Joaquin County (209) 476-1959
MS. MEAGAN ANNE STRICKLAND B.S.
Student in an Organized Health Care Education/Training Program
5405 N PERSHING AVE, STE. C1
STOCKTON, CA 95207
San Joaquin County (209) 476-1959

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Roughgarden's NPI number?

The NPI number for Kelly Roughgarden is 1174077614. It was assigned to this individual provider in the NPPES registry on August 13, 2016.

Where is Kelly Roughgarden located?

Kelly Roughgarden practices at 5405 N Pershing Ave Ste. C-1, Stockton, CA 95207. The listed phone number is (209) 476-1959.

What is Kelly Roughgarden's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Kelly Roughgarden was last updated on August 13, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.