NPIMap

Organization Active NPI

Miracle Kids Success Academy North

  • Developmental Disabilities Clinic/Center
  • Jonesboro, AR
National Provider Identifier
1255935680
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
MIRACLE KIDS SUCCESS ACADEMY NORTH
Practice address
806 Glendale St
Jonesboro, AR 72401-4455
Phone
(870) 333-2600
NPI assigned
Nov 25, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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

Authorized official

Name
Shelly A Keller
Title
Ceo
Phone
(870) 336-8100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X Primary
Rehabilitation Clinic/Center 261QR0400X

Addresses

Primary practice location

806 Glendale St
Jonesboro, AR 72401-4455

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 North4 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.

NPI Registry JSON

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

{
    "created_epoch": "1606262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1255935680",
    "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": "806 GLENDALE ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014455",
            "telephone_number": "870-333-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE KIDS SUCCESS ACADEMY NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-25",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "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": "870-336-8100"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Dec 18, 2020; 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.