Provider Demographics
NPI:1780210682
Name:JOUBERT, KATELYN PETITFILS (DO)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:PETITFILS
Last Name:JOUBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SOHO CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4200
Mailing Address - Country:US
Mailing Address - Phone:337-349-4616
Mailing Address - Fax:
Practice Address - Street 1:112 SOHO CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4200
Practice Address - Country:US
Practice Address - Phone:337-349-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program