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Individual

KENNETH PATRICK O'CONNOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
555 E COUNTY LINE RD, GREENWOOD, IN 46143-1063
(317) 497-2130
(317) 957-2730
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003872A
IN
363A00000X
Physician Assistant
99114487A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
264430H05
MEDICARE PTAN
IN
05
300074048
IN
Enumeration date
03/15/2022
Last updated
07/02/2026
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