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KENNETH ELAD FONGUCK
NPI 1265028781
Nurse Practitioner - Psychiatric/Mental Health in Woonsocket, RI

Active since December 18, 2020
1 CVS DR, WOONSOCKET, RI 02895(402) 419-6291 Get Directions Write a Review

NPPES record last updated: March 19, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 19, 2026, Dec 18, 2020 (2 updates tracked since 2020).

About Kenneth Elad Fonguck NPPES

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

KENNETH ELAD FONGUCK (NPI 1265028781) is an individual psychiatric/mental health provider in Woonsocket, Rhode Island, licensed in Georgia (APRN-NP296175) and active in the NPI registry since December 2020.

NPPES Registry Identity

NPI1265028781
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameKENNETH ELAD FONGUCK
Location Address1 CVS DRWoonsocket, RI 02895-6146
Mailing Address3768 Southfield CtLoganville, GA 30052-4863 · (404) 643-9031
Phone(402) 419-6291
Sole ProprietorYes
Enumeration DateDecember 18, 2020
Last NPPES UpdateMarch 19, 20262 updates tracked since enumeration
NPPES CertifiedMarch 19, 2026
✔ NPI 1265028781 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in GA · APRN-NP296175
1 CVS DR, Woonsocket, RI 02895
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Other Providers at the Same Location NPPES 20

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

KRISTEN JESSEE
Pharmacist
1 CVS DR
WOONSOCKET, RI 02895
Providence County (401) 765-1500
SARAH MARCHAND
Pharmacist
1 CVS DR
WOONSOCKET, RI 02895
Providence County (401) 602-4962
BEHAVIORAL HEALTH OF NEW JERSEY LLC
Social Worker (Clinical)
1 CVS DR
WOONSOCKET, RI 02895
Providence County (866) 389-2727
DESMOND TRIEU PHARMD
Pharmacist
1 CVS DR
WOONSOCKET, RI 02895
Providence County (855) 349-0930
KAYLA NOELLE BUTLER MSN, APRN, FNP-C
Nurse Practitioner
1 CVS DR
WOONSOCKET, RI 02895
Providence County (866) 389-2727
CVS HEALTHCARE PRACTICES PLLC
Nurse Practitioner (Family)
1 CVS DR
WOONSOCKET, RI 02895
Providence County (866) 389-2727
MS. CHRISTINE C SAWICKI RPH, MBA
Pharmacist
1 CVS DR
WOONSOCKET, RI 02895
Providence County (401) 765-1500
ANGELA PATTERSON NP
Nurse Practitioner (Family)
1 CVS DR
WOONSOCKET, RI 02895
Providence County (617) 694-7764

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 Kenneth Fonguck's NPI number?

The NPI number for Kenneth Fonguck is 1265028781. It was assigned to this individual provider in the NPPES registry on December 18, 2020.

Where is Kenneth Fonguck located?

Kenneth Fonguck practices at 1 CVS Dr, Woonsocket, RI 02895. The listed phone number is (402) 419-6291.

What is Kenneth Fonguck's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Kenneth Fonguck was last updated on March 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.