Provider Demographics
NPI:1124235114
Name:BRINSON, AMANDA BRAY (CPNP)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BRAY
Last Name:BRINSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BRINSON
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1702 MEDICAL PARK DR W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2878
Mailing Address - Country:US
Mailing Address - Phone:252-243-7944
Mailing Address - Fax:
Practice Address - Street 1:1702 MEDICAL PARK DR W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2878
Practice Address - Country:US
Practice Address - Phone:252-243-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-00956363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0050-00956OtherPRESCRIPTION NUMBER
NCMD 1356294OtherDEA NUMBER