Individual ProviderKhyra Elaine ClarkBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address110 Ryan Industrial Ct Ste 3&4, San Ramon, CA 94583-1592(800) 249-1266PECOS EnrollmentBased on the most recent information from CMS, provider Khyra Elaine Clark does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:34 AM.Profile DetailsProvider ID1073337663Provider TypeIndividualFull NameClark, Khyra ElaineGenderFemaleSole ProprietorNoEnumeration Date11/11/2024Last Updated5/5/2025Contact InformationPractice LocationPractice Address110 Ryan Industrial Ct Ste 3&4, San Ramon, CA 94583-1592Phone(800) 249-1266FaxUnlisted FaxMailing LocationMailing Address110 Ryan Industrial Ct Ste 3&4, San Ramon, CA 94583-1592PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer