Kenneth Elad Fonguck

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN-NP296175 Issued in GA

Practice address

1 CVS Dr
Woonsocket, RI 02895-6146

Phone

(402) 419-6291

NPI assigned

Dec 18, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1265028781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3768 SOUTHFIELD CT",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524863",
            "telephone_number": "404-643-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "402-419-6291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONGUCK",
        "first_name": "KENNETH",
        "middle_name": "ELAD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-18",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "APRN-NP296175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maleny Fitzpatrick, FNP-C
• Denise Flint, RN
• Andrea Ileana Flores, LPN
• Mariama Tejan Sie Foh, RN, MSN, DNP
• Caserra Folco
• Juan Fontanez Jr., PHARM D
• Alexis Ford, PHARMD, MPH
• Michael Brian Forman, D.M.D.
• Glenn G. Fort, MD
• Anne Fortier, LICSW

• Psychiatric/Mental Health Nurse Practitioner in Woonsocket, RI
• Providers in Woonsocket, RI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.