NPIMap

Organization Active NPI

Miracle Kids Success Academy North

  • Physical Therapist
  • Jonesboro, AR
National Provider Identifier
1902378037
Registry record updated Dec 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MIRACLE KIDS SUCCESS ACADEMY NORTH
Practice address
806 Glendale St
Jonesboro, AR 72401-4455
Phone
(870) 932-3600
NPI assigned
Dec 31, 2018
Organization subpart
Yes
Parent organization
MIRACLE KIDS SUCCESS ACADEMYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 31, 2018

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

Authorized official

Name
Shelly Keller
Title
Ceo/Owner
Phone
(870) 761-6680

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

806 Glendale St
Jonesboro, AR 72401-4455

Mailing address

806 Glendale St
Jonesboro, AR 72401-4455
Phone (870) 932-3600

National Provider Directory

National Provider Directory
Tax ID family
Miracle Kids Success Academy North4 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.

Locations

806 Glendale St
Jonesboro, AR 72401
Phone (870) 333-2600

NPI Registry JSON

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

{
    "created_epoch": "1546214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546214400000",
    "number": "1902378037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 GLENDALE ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014455",
            "telephone_number": "870-932-3600"
        },
        {
            "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": "870-932-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE KIDS SUCCESS ACADEMY NORTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIRACLE KIDS SUCCESS ACADEMY",
        "enumeration_date": "2018-12-31",
        "last_updated": "2018-12-31",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "870-761-6680"
    },
    "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 Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2018; 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.