NPIMap

Organization Active NPI

Miracle Kids Success Academy of Paragould

  • Physical Therapist
  • Paragould, AR
National Provider Identifier
1316405665
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MIRACLE KIDS SUCCESS ACADEMY OF PARAGOULD
Practice address
1910 Rector Rd
Paragould, AR 72450-2004
Phone
(870) 932-3600
NPI assigned
Mar 6, 2019
Last updated
Mar 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

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

Authorized official

Name
Mrs. Shelly KellerNPI 1629008321
Title
Ceo
Phone
(870) 761-6680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

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

1910 Rector Rd
Paragould, AR 72450-2004

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 Paragould4 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

1910 Rector Rd
Paragould, AR 72450
Phone (870) 240-8500

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551830400000",
    "number": "1316405665",
    "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",
            "fax_number": "870-932-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 RECTOR RD",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724502004",
            "telephone_number": "870-932-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE KIDS SUCCESS ACADEMY OF PARAGOULD",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-03-06",
        "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_name_prefix": "Mrs."
    },
    "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 Paragould, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.