Bethany Lynn Park, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601012241 Issued in MI

Practice address

27177 Lahser Rd
Southfield, MI 48034-4714

Phone

(989) 277-6478

NPI assigned

Feb 13, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1114781747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 ROYAL OAK ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495092711",
            "telephone_number": "989-277-6478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27177 LAHSER RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480344714",
            "telephone_number": "989-277-6478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "BETHANY",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shirley Ann Pardee
• Jalpa Southeast Parekh
• Parent Pledge
• Heenal Parikh, PHARM.D
• Ahyoung Lyoo Park, PHARMD
• Thomas Park, M.D.
• Helen Parker-Smith, R.N
• Arnise Octavia Parker-Walker, MA, LPC
• Amy Parker, DDS
• Andrea E Parker, RN

• Physician Assistant in Southfield, MI
• Providers in Southfield, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.