Provider Demographics
NPI:1699330639
Name:SPORTSMAN, DAKARI
Entity type:Individual
Prefix:
First Name:DAKARI
Middle Name:
Last Name:SPORTSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SUNSET COLONY DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-6577
Mailing Address - Country:US
Mailing Address - Phone:225-361-4093
Mailing Address - Fax:
Practice Address - Street 1:611 SUNSET COLONY DR
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-6577
Practice Address - Country:US
Practice Address - Phone:225-361-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX955613163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse