NPIMap

Organization Active NPI

Miracle Kids Success Academy Central

  • Clinical Child & Adolescent Psychologist
  • Jonesboro, AR
National Provider Identifier
1346168333
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
MIRACLE KIDS SUCCESS ACADEMY CENTRAL
Practice address
1607 Stone St
Jonesboro, AR 72401-5332
Phone
(870) 336-4100
NPI assigned
Jul 7, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Authorized official

Name
Jeremy Edward Ellis
Title
Controller
Phone
(870) 336-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC2200X Primary

Addresses

Primary practice location

1607 Stone St
Jonesboro, AR 72401-5332

Mailing address

1607 Stone St
Jonesboro, AR 72401-5332
Phone (870) 336-4100

National Provider Directory

National Provider Directory
Tax ID family
Miracle Kids Success Academy Central4 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

1607 Stone St
Jonesboro, AR 72401
Phone (870) 336-4100

NPI Registry JSON

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

{
    "created_epoch": "1783382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783382400000",
    "number": "1346168333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 STONE ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724015332",
            "telephone_number": "870-336-4100"
        },
        {
            "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": "NO",
        "enumeration_date": "2026-07-07",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "870-336-4100"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "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 Jul 7, 2026; 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.