Healthcare Provider Details

I. General information

NPI: 1336053362
Provider Name (Legal Business Name): DEACONESS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HEALTHY WAY
EVANSVILLE IN
47715-1102
US

IV. Provider business mailing address

5001 HEALTHY WAY
EVANSVILLE IN
47715-1102
US

V. Phone/Fax

Practice location:
  • Phone: 812-426-9700
  • Fax: 812-858-2196
Mailing address:
  • Phone: 812-426-9700
  • Fax: 812-858-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHERYL ANNETTE WATHEN
Title or Position: CFO
Credential:
Phone: 812-450-3296