Provider Demographics
NPI:1447924634
Name:VAUGHTERS, DASANI MELODIE RENAE
Entity type:Individual
Prefix:MS
First Name:DASANI
Middle Name:MELODIE RENAE
Last Name:VAUGHTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 CAPRICORN LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5924
Mailing Address - Country:US
Mailing Address - Phone:254-458-4419
Mailing Address - Fax:
Practice Address - Street 1:5302 CAPRICORN LOOP
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5924
Practice Address - Country:US
Practice Address - Phone:254-458-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer