# DEACONESS SPECIALITY PHYSICIANS, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407428519
- **Authorized official:** CHERYL ANNETTE WATHEN (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (812) 450-3296

## Contact information

- **Practice address:** 120 SE 4TH ST, EVANSVILLE, IN 47708-1607
- **Practice address phone:** (812) 426-6638
- **Practice address fax:** (812) 858-6802
- **Mailing address:** PO BOX 1230, EVANSVILLE, IN 47706-1230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 207RR0500X | Rheumatology Physician | — | NULL | — |
| 207RR0500X | Rheumatology Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/16/2021
- **Last updated:** 09/30/2024