Provider Demographics
NPI:1861265019
Name:JOUBERT, KEYOSHA MONEKE (MA)
Entity type:Individual
Prefix:
First Name:KEYOSHA
Middle Name:MONEKE
Last Name:JOUBERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KEYOSHA
Other - Middle Name:MONEKE
Other - Last Name:JOUBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDICAL ASSISTANT
Mailing Address - Street 1:322 KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-3555
Mailing Address - Country:US
Mailing Address - Phone:337-522-4246
Mailing Address - Fax:
Practice Address - Street 1:322 KNOX AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-3555
Practice Address - Country:US
Practice Address - Phone:337-522-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMAC-5748246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy