Healthcare Provider Details

I. General information

NPI: 1831996222
Provider Name (Legal Business Name): DEACONESS SPECIALTY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 N ELM ST
HENDERSON KY
42420-2768
US

IV. Provider business mailing address

PO BOX 632111
CINCINNATI OH
45263-2111
US

V. Phone/Fax

Practice location:
  • Phone: 270-831-7937
  • Fax: 270-831-7939
Mailing address:
  • Phone: 812-450-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

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