Provider Demographics
NPI:1861628695
Name:VINSON, BREONY MILLER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BREONY
Middle Name:MILLER
Last Name:VINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7574
Mailing Address - Country:US
Mailing Address - Phone:910-763-2476
Mailing Address - Fax:
Practice Address - Street 1:16747 US HIGHWAY 17 STE 114
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3086
Practice Address - Country:US
Practice Address - Phone:910-763-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant