Healthcare Provider Details

I. General information

NPI: 1336068550
Provider Name (Legal Business Name): DEACONESS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 DORBETT ST
JASPER IN
47546-2619
US

IV. Provider business mailing address

1005 DORBETT ST
JASPER IN
47546-2619
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-6879
  • Fax:
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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