Provider Demographics
NPI:1720713266
Name:JOUBERT, JENNIFER HAWKINS
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HAWKINS
Last Name:JOUBERT
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 1:2011 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4744
Mailing Address - Country:US
Mailing Address - Phone:337-540-2731
Mailing Address - Fax:
Practice Address - Street 1:2011 5TH ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-4744
Practice Address - Country:US
Practice Address - Phone:337-540-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide