Active NPI
Miracle Kids Success Academy of Trumann
- Clinical Child & Adolescent Psychologist
- Trumann, AR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- Legal business name
- MIRACLE KIDS SUCCESS ACADEMY OF TRUMANN
- Practice address
- 1005 Balcom LN
Trumann, AR 72472-9502 - Phone
- (870) 481-0779
- Fax
- (877) 481-0779
- NPI assigned
- Aug 20, 2026
- Last updated
- Aug 20, 2026
- Organization subpart
- No
NPPES NPI Registry
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) 932-3600
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | Primary |
Addresses
Primary practice location
1005 Balcom LN
Trumann, AR 72472-9502
Mailing address
1005 Balcom LN
Trumann, AR 72472-9502
Phone (870) 481-0779
National Provider Directory
National Provider Directory- Tax ID family
- Miracle Kids Success Academy of Trumann
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Physical Therapist
- Trumann, AR
- NPI 1063979243
-
- Rehabilitation Clinic/Center
- Trumann, AR
- NPI 1326505504
-
- Developmental Disabilities Clinic/Center
- Trumann, AR
- NPI 1639773054
Locations
1005 Balcom Ln
Trumann, AR 72472
Phone (870) 418-1000
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.
-
- Speech-Language Pathologist
- Jonesboro, AR
- NPI 1629008321
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1787184000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1787184000000",
"number": "1538075403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1005 BALCOM LN",
"city": "TRUMANN",
"state": "AR",
"postal_code": "724729502",
"telephone_number": "870-481-0779",
"fax_number": "877-481-0779"
},
{
"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": "870-481-0779",
"fax_number": "877-481-0779"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MIRACLE KIDS SUCCESS ACADEMY OF TRUMANN",
"organizational_subpart": "NO",
"enumeration_date": "2026-08-20",
"last_updated": "2026-08-20",
"certification_date": "2026-08-20",
"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": "870-932-3600"
},
"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 Trumann, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.