NPIMap

Organization Active NPI

Miracle Kids Success Academy North

  • Clinical Child & Adolescent Psychologist
  • Jonesboro, AR
National Provider Identifier
1912813874
Registry record updated Aug 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
MIRACLE KIDS SUCCESS ACADEMY NORTH
Practice address
806 Glendale St
Jonesboro, AR 72401-4455
Phone
(870) 333-2600
Fax
(870) 300-2337
NPI assigned
Aug 20, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2026

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

Specialties & licenses 1

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

Addresses

Primary practice location

806 Glendale St
Jonesboro, AR 72401-4455

Mailing address

806 Glendale St
Jonesboro, AR 72401-4455
Phone (870) 333-2600

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": "1787184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787184000000",
    "number": "1912813874",
    "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": "870-333-2600",
            "fax_number": "870-300-2337"
        },
        {
            "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",
            "fax_number": "870-300-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE KIDS SUCCESS ACADEMY NORTH",
        "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 Jonesboro, 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.

Verify at the official NPI Registry.