Healthcare Provider Details

I. General information

NPI: 1033077987
Provider Name (Legal Business Name): TINY MIRACLES PEDIATRIC DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LUCKNEY STATION RD
FLOWOOD MS
39232-8402
US

IV. Provider business mailing address

109 LUCKNEY STATION RD
FLOWOOD MS
39232-8402
US

V. Phone/Fax

Practice location:
  • Phone: 601-421-9367
  • Fax: 601-510-9196
Mailing address:
  • Phone: 601-421-9367
  • Fax: 601-510-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: BRENDA BARRON
Title or Position: OWNER/ DIRECTOR
Credential:
Phone: 601-421-9367