Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tanner J. Nissly, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1518131093

Tanner J. Nissly, DO is a Family Practice in Minneapolis, Minnesota. Graduated from Kansas City University of Med & Biosciences, College of Osteo Med in 2007, 19 years ago. Practices with University of Minnesota Physicians, a 156-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
19
Trained at
Kansas City University of Med & Biosciences, College of Osteo Med
Licensed in
MN
In the registry since
2008
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

1020 W Broadway Ave Broadway Family Medicine
Minneapolis, MN 55411-2504
Phone: (612) 302-8209
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 50925 (MN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1518131093
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 16, 2008
Last updated in NPPESFebruary 15, 2013

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolKANSAS CITY UNIVERSITY OF MED & BIOSCIENCES, COLLEGE OF OSTEO MED
Graduated 2007 (19 years in practice)
Group practice University Of Minnesota Physicians — 156 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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