MIRACLE KIDS SUCCESS ACADEMY NORTH (NPI# 1912479452) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912479452 |
| Entity Type | Organization |
| Organization Name | MIRACLE KIDS SUCCESS ACADEMY NORTH |
| Practice Address |
806 Glendale St Jonesboro AR 72401-4455 |
| Mailing Address |
1900 Stillwater Dr Jonesboro AR 72404-9119 |
| Practice Telephone | 8703332600 |
| Mailing Telephone | 8703332600 |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2018-12-21 |
| Authorized Official Name | SHELLY KELLER (CEO/OWNER) |
| Authorized Official Telephone | 8707616680 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902378037 | Miracle Kids Success Academy North | Occupational Therapist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2018-12-31 |
| Street Address |
806 GLENDALE ST |
| City | JONESBORO |
| State | AR |
| Zip Code | 72401-4455 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114063138 | Brandie P. Lieblong | Physical Therapist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2007-01-29 |
| 1932700515 | Ashley Tomlinson | Day Training/Habilitation Specialist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2020-11-02 |
| 1689282303 | Alissa M Lee | Day Training/Habilitation Specialist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2020-07-20 |
| 1851917512 | Jamie Pasmore | Registered Nurse | 806 Glendale St, Jonesboro, AR 72401-4455 | 2020-06-18 |
| 1952941395 | Jonathan Turner | Occupational Therapist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2020-01-14 |
| 1386282309 | Hannah Morgan Stone | Day Training/Habilitation Specialist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2019-12-20 |
| 1952948994 | Jordan Tyler Weaver | Day Training/Habilitation Specialist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2019-12-10 |
| 1861039802 | Elizabeth Tate Lawson | Day Training/Habilitation Specialist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2019-12-10 |
| 1679119036 | Carly Nichols Glidewell | Occupational Therapist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2019-11-20 |
| 1659916542 | Rebecca Ann Chisom | Day Training/Habilitation Specialist | 806 Glendale St, Jonesboro, AR 72401-4455 | 2019-11-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453368 | Mariah Kay Jackson | Physical Therapy Assistant | Creative Kids Therapy, Jonesboro, AR 72401 | 2020-10-05 |
| 1821606005 | Kafayat Folake Iyanda | Specialist/Technologist | 2105 East Aggie Rd, Jonesboro, AR 72401 | 2020-07-14 |
| 1053936310 | Josh Roberts | Physical Therapist | 1010 South Main St, Jonesboro, AR 72401 | 2020-06-12 |
| 1003449687 | Amy Mary Elizabeth Daughhetee | Nurse Practitioner | 225 East Washington Ave, Jonesboro, AR 72401 | 2020-02-21 |
| 1871126698 | Sarah Lowtharp | Clinical Nurse Specialist | 225 East Washington Ave., Jonesboro, AR 72401 | 2020-02-20 |
| 1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
| 1265073704 | Michael Bruce Collie | Registered Nurse | 837 Williett Road, Jonesboro, AR 72401 | 2019-10-07 |
| 1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
| 1841843943 | Destinee Katrina Cole | Specialist/Technologist | 2015 Aggie Rd, Jonesboro, AR 72401 | 2019-07-18 |
| 1699250472 | Jessica Marie Mcnatt | Occupational Therapist | 907 County Road 753, Jonesboro, AR 72401 | 2018-09-27 |
| Find all providers in zip 72401 | ||||
| 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 |
| 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 |
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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.