Active NPI
Nathan Michael Tellers, ATC
- Athletic Trainer
- St Bonifacius, MN
National Provider Identifier
1922092675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1745
- Practice address
- 4246 Spruce Rd
St Bonifacius, MN 55375-1315 - Phone
- (952) 467-1915
- NPI assigned
- Sep 8, 2005
- Sex
- Male
- 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 | 1745 | MN | Primary |
Addresses
Primary practice location
4246 Spruce Rd
St Bonifacius, MN 55375-1315
Mailing address
4246 Spruce Rd
St Bonifacius, MN 55375-1315
Phone (952) 467-1915
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 |
|---|---|---|---|
| 1745 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1922092675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4246 SPRUCE RD",
"city": "ST BONIFACIUS",
"state": "MN",
"postal_code": "553751315",
"telephone_number": "952-467-1915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4246 SPRUCE RD",
"city": "ST BONIFACIUS",
"state": "MN",
"postal_code": "553751315",
"telephone_number": "952-467-1915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TELLERS",
"first_name": "NATHAN",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-08",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "1745",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Bonifacius, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.