OrganizationByron Kemp Clark(<Unavail>)Nurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address5056 W 4th St # 100, Hattiesburg, MS 39402-1069(601) 410-6525PECOS EnrollmentBased on the most recent information from CMS, provider Byron Kemp 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 2 days ago.Profile DetailsProvider ID1871392860Provider TypeOrganizationFull NameByron Kemp ClarkOther Name<Unavail>SubpartNoEnumeration Date3/11/2025Last Updated6/11/2025Contact InformationPractice LocationPractice Address5056 W 4th St # 100, Hattiesburg, MS 39402-1069Phone(601) 410-6525Fax(949) 288-0396Mailing LocationMailing Address5056 W 4th St # 100, Hattiesburg, MS 39402-1069Phone(601) 410-6525FaxUnlisted FaxAuthorized OfficialNameClark, Byron (Office Manager/ Clinic Owner)Phone(601) 410-6525Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer