Active NPI
Kelly Shaner, ATC
- Athletic Trainer
- Redwood Falls, MN
National Provider Identifier
1700258761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2687
- Practice address
- 100 Fallwood Rd
Redwood Falls, MN 56283-1828 - Phone
- (507) 637-4500
- NPI assigned
- Oct 29, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2687 | MN | Primary |
Addresses
Primary practice location
100 Fallwood Rd
Redwood Falls, MN 56283-1828
Mailing address
23789 490TH Ave
Sanborn, MN 56083-4106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2687 | MN | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446076800000",
"number": "1700258761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23789 490TH AVE",
"city": "SANBORN",
"state": "MN",
"postal_code": "560834106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 FALLWOOD RD",
"city": "REDWOOD FALLS",
"state": "MN",
"postal_code": "562831828",
"telephone_number": "507-637-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANER",
"first_name": "KELLY",
"name_prefix": "Ms.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-29",
"last_updated": "2015-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "2687",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redwood Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.