Healthcare Provider Details

I. General information

NPI: 1144664665
Provider Name (Legal Business Name): DEETTA KAY VANCE DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEETTA KAY CLOUSE

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E WALNUT ST STE A
EVANSVILLE IN
47713-2460
US

IV. Provider business mailing address

610 E WALNUT ST STE A
EVANSVILLE IN
47713-2460
US

V. Phone/Fax

Practice location:
  • Phone: 844-999-0019
  • Fax: 888-736-6686
Mailing address:
  • Phone: 844-999-0019
  • Fax: 888-736-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28178817A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2012023980
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number120654
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004949A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014002636
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5376265111
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28178817A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: