MEDICARE: BROOKVILLE EXPRESS CARE & WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1144047440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKVILLE EXPRESS CARE & WELLNESS CENTER

Provider Business Mailing Address
First Line	:	430 ARLINGTON RD STE B
Second Line	:
City	:	BROOKVILLE
State	:	OH
Zip	:	45309-1103
Country	:	US
Telephone Number	:	937-741-4888
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 ARLINGTON RD STE B
Second Line	:
City	:	BROOKVILLE
State	:	OH
Zip	:	45309-1103
Country	:	US
Telephone Number	:	937-641-9389
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MRS. SHELBY GONSALES
Credential	:	APRN-CNP
Telephone Number	:	937-867-7700

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	04/09/2025

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Directions to “BROOKVILLE EXPRESS CARE & WELLNESS CENTER ” Practice Location

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