Individual
JENTRY E O'DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13121 OLIO RD STE 300, FISHERS, IN 46037-7240
(317) 621-1310
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002254A
IN
363A00000X
Physician Assistant
TC391
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300003519
—
IN
Enumeration date
07/22/2015
Last updated
01/19/2026
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