Individual ProviderTreston Grant Clark-LaruePhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address4350 Us 421 S, Lillington, NC 27546-6760(910) 893-1210(814) 241-3992PECOS EnrollmentBased on the most recent information from CMS, provider Treston Grant Clark-Larue 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 2 days ago.Profile DetailsProvider ID1225703853Provider TypeIndividualFull NameClark-Larue, Treston GrantCredentialPA-CGenderMaleSole ProprietorNoEnumeration Date8/16/2021Last Updated8/16/2021Contact InformationPractice LocationPractice Address4350 Us 421 S, Lillington, NC 27546-6760Phone(910) 893-1210FaxUnlisted FaxMailing LocationMailing Address142 Westwick Ln Apt 19, Fayetteville, NC 28314-2732Phone(814) 241-3992FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer