NPIMap

Organization Active NPI

Miracle Kids Success Academy of Trumann

  • Physical Therapist
  • Trumann, AR
National Provider Identifier
1063979243
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MIRACLE KIDS SUCCESS ACADEMY OF TRUMANN
Practice address
1005 Balcom LN
Trumann, AR 72472-9502
Phone
(870) 761-6680
NPI assigned
Feb 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shelly Keller, MCD, CCC-SLP
Title
Ceo
Phone
(870) 761-6680

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

1005 Balcom LN
Trumann, AR 72472-9502

Mailing address

1900 Stillwater Dr
Jonesboro, AR 72404-9119
Phone (870) 932-3600

National Provider Directory

National Provider Directory
Tax ID family
Miracle Kids Success Academy of Trumann4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1900 Stillwater Dr
Jonesboro, AR 72404
Phone (870) 932-6300

1005 Balcom Ln
Trumann, AR 72472
Phone (870) 418-1000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551052800000",
    "number": "1063979243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 STILLWATER DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724049119",
            "telephone_number": "870-932-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 BALCOM LN",
            "city": "TRUMANN",
            "state": "AR",
            "postal_code": "724729502",
            "telephone_number": "870-761-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE KIDS SUCCESS ACADEMY OF TRUMANN",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-25",
        "last_updated": "2019-02-25",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-761-6680",
        "authorized_official_credential": "MCD, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumann, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.