MIRACLE KIDS SUCCESS ACADEMY, INC. (NPI# 1568799658) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568799658 |
| Entity Type | Organization |
| Organization Name | MIRACLE KIDS SUCCESS ACADEMY, INC. |
| Practice Address |
1900 Stillwater Dr Jonesboro AR 72404-9119 |
| Practice Telephone | 8709323600 |
| Practice Fax Number | 8709323611 |
| Mailing Telephone | 8709323600 |
| Mailing Fax Number | 8709323611 |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2019-12-04 |
| Authorized Official Name | SHELLY KELLER (OWNER/PRESIDENT) |
| Authorized Official Telephone | 8709323600 |
| Authorized Official Credential | MCD, CCC-SLP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 179889724 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639791411 | Miracle Kids Success Academy, Inc. | Clinic/Center | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-05-14 |
| 1356671366 | Miracle Kids Success Academy, Inc. | Clinic/Center | 200 General St, Batesville, AR 72501-9407 | 2010-01-14 |
| Street Address |
1900 STILLWATER DR |
| City | JONESBORO |
| State | AR |
| Zip Code | 72404-9119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629008321 | Shelly Keller | Speech-Language Pathologist | 1900 Stillwater Dr, Jonesboro, AR 72404 | 2006-07-05 |
| 1821696725 | Sarah Deweese | Day Training/Habilitation Specialist | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-10-13 |
| 1417555319 | Olivia Lawshe | Day Training/Habilitation Specialist | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-10-13 |
| 1952909863 | Martha Aldridge | Driver | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-10-13 |
| 1811595713 | Kiara Minor | Driver | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-10-13 |
| 1386241263 | Kawaiala Mullen | Day Training/Habilitation Specialist | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-10-05 |
| 1689280984 | Amanda Pemberton | Day Training/Habilitation Specialist | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-09-22 |
| 1104432400 | Morgan Kilgore | Day Training/Habilitation Specialist | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-09-22 |
| 1407461288 | Howell Davis | Driver | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-09-09 |
| 1629683479 | John Huffman | Driver | 1900 Stillwater Dr, Jonesboro, AR 72404-9119 | 2020-09-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740745967 | Imove, LLC | Physical Therapist | 8700 S. Caraway Rd., Apt. L2, Jonesboro, AR 72404 | 2019-02-01 |
| 1245728914 | Karina Coats | Nurse Anesthetist, Certified Registered | 2409 Skyline Pt, Jonesboro, AR 72404 | 2018-04-27 |
| 1619325263 | Kathryn Meyers | Specialist/Technologist | 1614 Latourette Ln Apt 2, Jonesboro, AR 72404 | 2016-05-24 |
| 1922476571 | Tmj and Facial Pain Center,llc | Dentist | 2600 Browns Lane, Ste B, Jonesboro, AR 72404 | 2015-09-11 |
| 1265828156 | Hd Dental, Pa Dba Smile Dental | Dentist | 6009 Highway 1 South, Jonesboro, AR 72404 | 2015-04-08 |
| 1124445358 | Tanner Wilson Jarrett | Occupational Therapy Assistant | 3114 Fox Road Suite A, Jonesboro, AR 72404 | 2014-03-26 |
| 1154759793 | Kasey Boyd | Specialist/Technologist | 1717 Hwy 163, Jonesboro, AR 72404 | 2013-10-17 |
| 1578848610 | Maria Ivonne Norman | Physical Therapist | 8700 S. Caraway Rd. Apt. L2, (the Meadows), Jonesboro, AR 72404 | 2011-10-20 |
| 1003198839 | Rachel Hollimon Golden | Speech-Language Pathologist | 4410 Harrisburg Rd., Jonesboro, AR 72404 | 2011-09-19 |
| 1225358021 | Darrell R Gann | Physical Therapy Assistant | 6040 Beaver Creek, Jonesboro, AR 72404 | 2010-06-03 |
| Find all providers in zip 72404 | ||||
| Taxonomy Code | 261QR0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124103031 | Physiotherapy Associates Inc | Clinic/Center | 335 Upper Riverdale Road, Ste B10, Jonesboro, GA 30236-1071 | 2006-10-26 |
| 1912479452 | Miracle Kids Success Academy North | Clinic/Center | 806 Glendale St, Jonesboro, AR 72401-4455 | 2018-12-21 |
| 1366832438 | Thera-play Pediatric Therapy Associates | Clinic/Center | 3114 Fox Road, Jonesboro, AR 72404-9322 | 2015-01-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083272223 | Pediatric Therapy Connections LLC | Clinic/Center | 7601 Westminister Pl, Fort Smith, AR 72903 | 2019-06-03 |
| 1417512369 | Kids Unlimited Learning Academy of Springdale | Clinic/Center | 1268 Electric Ave, Springdale, AR 72764-7498 | 2019-05-07 |
| 1063912871 | Sygnificare, LLC | Clinic/Center | 10201 W Markham St Ste 105, Little Rock, AR 72205-2180 | 2018-02-19 |
| 1962853358 | Quality Rehab-st. Francis LLC | Clinic/Center | 1800 Stephens Dr, Forrest City, AR 72335-8118 | 2016-06-27 |
| 1588037196 | Wolf Wellness Center, Pllc | Clinic/Center | 23 Parkcliff Dr, Holiday Island, AR 72631-9230 | 2015-11-04 |
| 1740607431 | Kidz Palace Therapy LLC | Clinic/Center | 7123 Interstate 30 Ste 25, Little Rock, AR 72209-3184 | 2014-03-20 |
| 1699114132 | Kids Unlimited Learning Academy of Cabot, Inc. | Clinic/Center | 2792 S 2nd St, Suites B & C, Cabot, AR 72023-7020 | 2013-06-18 |
| 1548569585 | East Arkansas Physical Therapy | Clinic/Center | 3150 N Washington, Forrest City, AR 72335 | 2011-03-16 |
| 1205024908 | In Sight Low Vision Services LLC | Clinic/Center | 601 County Road 155, Eureka Springs, AR 72632-9229 | 2007-10-07 |
| 1679779920 | Kymes-lyons Physical Therapy and Sports Performance Center Pa | Clinic/Center | 575 Club Lane, Conway, AR 72032 | 2007-06-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.