Organization
DEACONESS CLINIC, INC
Active
Other names
Deaconess Clinic I
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A WATHEN (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
1035 N ELM ST, HENDERSON, KY 42420-2712
(270) 827-4596
(270) 826-2838
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(270) 827-4596
(270) 826-2838
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100051620
—
KY
Enumeration date
03/29/2013
Last updated
08/10/2017
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