NPIMap

Organization Active NPI

Deaconess Clinic, Inc.

  • Pediatric Cardiology Physician
  • Henderson, KY
National Provider Identifier
1174490940
Registry record updated Oct 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
Legal business name
DEACONESS CLINIC, INC.
Practice address
1305 N Elm St
Henderson, KY 42420-2783
Phone
(812) 450-6879
Fax
(812) 858-4586
NPI assigned
Oct 17, 2025
Last updated
Oct 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cheryl Annette Wathen
Title
Cfo
Phone
(812) 450-3296

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0202X Primary

Addresses

Primary practice location

1305 N Elm St
Henderson, KY 42420-2783

Mailing address

1305 N Elm St
Henderson, KY 42420-2783
Phone (812) 450-6879

National Provider Directory

National Provider Directory
Tax ID family
Deaconess Clinic Inc101 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1760659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760659200000",
    "number": "1174490940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 N ELM ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202783",
            "telephone_number": "812-450-6879",
            "fax_number": "812-858-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 N ELM ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202783",
            "telephone_number": "812-450-6879",
            "fax_number": "812-858-4586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-17",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.