Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Bethany Lynn Park, PA-C

Individual provider Physician Assistant · NPI 1114781747

Bethany Lynn Park, PA-C is a Physician Assistant in Southfield, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in
MI
In the registry since
2024
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

27177 Lahser Rd
Southfield, MI 48034-4714
Phone: (989) 277-6478
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601012241 (MI)

Record details

NPI number1114781747
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedFebruary 13, 2024
Last updated in NPPESFebruary 13, 2024
Certification dateFebruary 13, 2024

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