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General NPI Number Information
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NPI Number | 1174490940
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Entity Type | Organization
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Legal Business Name | DEACONESS CLINIC, INC.
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 1305 N ELM ST
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City | HENDERSON
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State | KY
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Zip | 42420-2783
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Country | US
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Telephone | 812-450-6879
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Fax | 812-858-4586
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Provider Business Mailing Address
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Address Line | 1305 N ELM ST
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City | HENDERSON
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State | KY
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Zip | 42420-2783
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Country | US
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Telephone | 812-450-6879
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Fax | 812-858-4586
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Authorized Official
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Title or Position | CFO
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Name | CHERYL ANNETTE WATHEN
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Credential |
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Telephone | 812-450-3296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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