Active NPI
Justline Tah
- Adult Psychiatric/Mental Health Registered Nurse
- Washington, DC
National Provider Identifier
1114463346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Psychiatric/Mental Health Registered Nurse
- License
- 500018807
- Practice address
- 4017 Minnesota Ave NE
Washington, DC 20019-3541 - Phone
- (202) 388-9202
- Fax
- (202) 388-4339
- NPI assigned
- Jan 11, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Psychiatric/Mental Health Registered Nurse | 163WP0809X | 500018807 | DC | Primary |
| Case Manager/Care Coordinator | 171M00000X |
Addresses
Primary practice location
4017 Minnesota Ave NE
Washington, DC 20019-3541
Mailing address
660 Streford Way
Unit 210
Hyattsville, MD 20785-1234
Phone (301) 648-8594
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 500018807 | DC | MD | Adult Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746576000000",
"number": "1114463346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "660 STREFORD WAY",
"address_2": "UNIT 210",
"city": "HYATTSVILLE",
"state": "MD",
"postal_code": "207851234",
"telephone_number": "301-648-8594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4017 MINNESOTA AVE NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200193541",
"telephone_number": "202-388-9202",
"fax_number": "202-388-4339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAH",
"first_name": "JUSTLINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-11",
"last_updated": "2025-05-07",
"certification_date": "2025-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0809X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
"state": "DC",
"license": "500018807",
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.