NPIMap

Organization Active NPI

Miracle Kids Success Academy Central

  • Rehabilitation Clinic/Center
  • Jonesboro, AR
National Provider Identifier
1225739048
Registry record updated Mar 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
MIRACLE KIDS SUCCESS ACADEMY CENTRAL
Practice address
1607 Stone St
Jonesboro, AR 72401-5332
Phone
(870) 336-4100
NPI assigned
Mar 17, 2023
Organization subpart
Yes
Parent organization
MIRACLE KIDS SUCCESS ACADEMY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

1607 Stone St
Jonesboro, AR 72401-5332

Mailing address

3127 Southwest Dr Ste a
Jonesboro, AR 72404-8404
Phone (870) 336-8100

National Provider Directory

National Provider Directory
Tax ID family
Miracle Kids Success Academy Central4 organizations share this tax ID, including this one
Part of
Miracle Kids Success Academy

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1225739048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3127 SOUTHWEST DR STE A",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724048404",
            "telephone_number": "870-336-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 STONE ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724015332",
            "telephone_number": "870-336-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE KIDS SUCCESS ACADEMY CENTRAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIRACLE KIDS SUCCESS ACADEMY, INC.",
        "enumeration_date": "2023-03-17",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-761-6680",
        "authorized_official_credential": "MCD, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; 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.