Individual provider · Type 1 NPI
Kenneth Elad Fonguck
Psychiatric/Mental Health Nurse Practitioner · Woonsocket, RI
NPI number
1265028781
Active
Practice location
1 Cvs Dr
Woonsocket, RI 02895-6146
Mailing address
3768 Southfield Ct
Loganville, GA 30052-4863
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | APRN-NP296175 (GA) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1265028781
Kenneth Elad Fonguck's National Provider Identifier is 1265028781, issued on Dec 18, 2020. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Woonsocket, RI. The record was last updated on Mar 19, 2026.