Healthcare Provider Details

I. General information

NPI: 1144047440
Provider Name (Legal Business Name): BROOKVILLE EXPRESS CARE & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 ARLINGTON RD STE B
BROOKVILLE OH
45309-1103
US

IV. Provider business mailing address

430 ARLINGTON RD STE B
BROOKVILLE OH
45309-1103
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-9389
  • Fax:
Mailing address:
  • Phone: 937-741-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHELBY GONSALES
Title or Position: NURSE PRACTITIONER
Credential: APRN-CNP
Phone: 937-867-7700