Deaconess Clinc Inc

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

DEACONESS CLINC INC

Practice address

3329 W Deyoung St
Marion, IL 62959-5884

Phone

(812) 450-6966

NPI assigned

Feb 23, 2024

Organization subpart

No

Name

Cheryl Annette Wathen

Title

Cfo

Phone

(812) 450-3296

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Deaconess Clinc Inc (99 organizations share this tax ID)

• Deaconess Clinic - At Work Marion Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 23, 2024.

{
    "created_epoch": "1708646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1295591634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631767",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452631767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3329 W DEYOUNG ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595884",
            "telephone_number": "812-450-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS CLINC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "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": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Clinic - At Work Marion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rachel Dawkins, LCSW
• Amanda K Dawson, RN
• Amanda Jo Day, RN
• Shobha Dayal, MD
• Jeffery S Deacon, DPM
• Deaconess Illinois Clinic, Inc
• Deaconess Illinois Clinic, Inc
• Deaconess Illinois Clinic, Inc
• Deaconess Illinois Clinic, Inc
• Deaconess Illinois Clinic, Inc

• All providers in Marion, IL
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.