Khudsiatu Tucker

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R166523 Issued in MD

Practice address

5632 Annapolis Rd Ste 11
Bladensburg, MD 20710-2213

Phone

(240) 486-7097

NPI assigned

Jul 20, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA, DC, MD3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

May accept Medicare assignment

Group practices

Addiction Medication Clinic LLCGroup PAC ID 9739660747, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Addiction Medication Clinic LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Westminster, MD
  • NPI 1386215705

  MD

  Medicare reassignment Care Compare group
• Abs Clinical Services

  • Clinic/Center
  • Bladensburg, MD
  • NPI 1255916144
  NPD Authorized official
• Minuteclinic Diagnostic of Virginia LLC

  • Family Nurse Practitioner
  • Leesburg, VA
  • NPI 1417076829

  VA

  Medicare reassignment
• Care Go Inc

  • Multi-Specialty Clinic/Center
  • Capitol Heights, MD
  • NPI 1467101220
  NPD
• Addiction Wellness Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Quantico, MD
  • NPI 1275203275

  Psychiatric/Mental Health

  NPD (past)
• Addiction Wellness Center LLC

  • Adult Health Nurse Practitioner
  • Quantico, MD
  • NPI 1912760877
  NPD (past)

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

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785283200000",
    "number": "1831707488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5632 ANNAPOLIS RD STE 11",
            "city": "BLADENSBURG",
            "state": "MD",
            "postal_code": "207102213",
            "telephone_number": "240-486-7097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5632 ANNAPOLIS RD STE 11",
            "city": "BLADENSBURG",
            "state": "MD",
            "postal_code": "207102213",
            "telephone_number": "240-486-7097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "407 Malcolm Dr",
            "address_purpose": "LOCATION",
            "city": "Westminster",
            "state": "MD",
            "postal_code": "211576107",
            "country_code": "US",
            "telephone_number": "443-547-2964",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6791 James Madison Hwy",
            "address_purpose": "LOCATION",
            "city": "Warrenton",
            "state": "VA",
            "postal_code": "201879534",
            "country_code": "US",
            "telephone_number": "540-655-2936",
            "fax_number": "540-736-4371",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1812 Newport Gap Pike",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "DE",
            "postal_code": "198086179",
            "country_code": "US",
            "telephone_number": "302-500-5997",
            "fax_number": "302-500-5870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "511 N Boardwalk Fl 1",
            "address_purpose": "LOCATION",
            "city": "Rehoboth Beach",
            "state": "DE",
            "postal_code": "199712162",
            "country_code": "US",
            "telephone_number": "240-486-7097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "KHUDSIATU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-20",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "DC",
            "license": "RN1023913",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024179570",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R166523",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R166523",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "DE",
            "license": "L8-0011097",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "547056100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831707488",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gensinta Ndum Tizem
• Claris Njweng Toh
• Naomi Abena Tolen
• Olive Wintoh Tubuo
• Patience Nabuin Tubuo
• Beatrice Azu Ugomma
• Ngozi Uchenna Uwakwe, RPH
• Vicken Poochikian MD P a
• Gloria Harolette Walker
• Oyamiwa Walker

• Psychiatric/Mental Health Nurse Practitioner in Bladensburg, MD
• Providers in Bladensburg, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.