SOCO PRIMARY CARE CLINIC (NPI# 1124677729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124677729 |
| Entity Type | Organization |
| Organization Name | SOCO PRIMARY CARE CLINIC |
| Practice Address |
1310 Fortino Blvd Ste D Pueblo CO 81008-2076 |
| Mailing Address |
1310 Fortino Blvd Pueblo CO 81008-2075 |
| Practice Telephone | 7195821898 |
| Practice Fax Number | 7196214098 |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2020-04-30 |
| Authorized Official Name | NICOLE LYNN BETTS (PRESIDENT, AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 7195821898 |
| Authorized Official Credential | NP, AGNP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | SoCO Primary Care Clinic | 1310 Fortino Blvd, Suite D, Pueblo, CO 81008 |
| Street Address |
1310 FORTINO BLVD STE D |
| City | PUEBLO |
| State | CO |
| Zip Code | 81008-2076 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417327461 | Nicole Betts | Registered Nurse | 1310 Fortino Blvd Ste D, Pueblo, CO 81008 | 2015-10-02 |
| 1588223598 | Chelsea L Frey | Nurse Practitioner | 1310 Fortino Blvd Ste D, Pueblo, CO 81008-2076 | 2019-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164058913 | Healthone Clinic Services - Oncology Hematology LLC | Internal Medicine | 3678 Parker Blvd, Pueblo, CO 81008 | 2020-03-12 |
| 1073026423 | Carmel Community Living Corporation | Respite Care | 2003 Northmoor Terrace, Suite 100, Pueblo, CO 81008 | 2017-11-08 |
| 1568987121 | Hannah Vivian Roadruck | Pharmacist | 4200 Dillon Dr., Pueblo, CO 81008 | 2017-08-04 |
| 1184170425 | Brett Burana | Dentist | 729 Us-50, Pueblo, CO 81008 | 2016-08-28 |
| 1760832885 | Irby Dental Cottage | Dental Hygienist | 2099 West St # 50, Suite 180, Pueblo, CO 81008 | 2016-06-20 |
| 1649624362 | Curley Peak Dentistry Pllc | Dentist | 1640 W Fortino Blvd, Pueblo, CO 81008 | 2016-04-19 |
| 1336507847 | Kyle Tipton | Nurse Anesthetist, Certified Registered | 4741 Eagleridge Circle, 206, Pueblo, CO 81008 | 2016-01-29 |
| 1407211931 | Center At Park West, LLC | Skilled Nursing Facility | 3727 Parker Blvd., Pueblo, CO 81008 | 2015-12-29 |
| 1437578028 | Pueblo Modern Dentistry and Orthodontics, LLP | Dentist | 727 Us Hwy 50 West, Pueblo, CO 81008 | 2014-04-10 |
| 1063838415 | Regina Stephan | Occupational Therapist | 4776 Eagleridge Circle, Va Eastern Colorado Health Care System, Pueblo, CO 81008 | 2014-03-10 |
| Find all providers in zip 81008 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417177007 | Bernice Eleanora Barnes | Nurse Practitioner | 4112 Outlook Blvd Ste 255, Pueblo, CO 81008-1667 | 2007-04-26 |
| 1821166422 | Judy Ann Saiz | Nurse Practitioner | 1401 W 17th St, Pueblo, CO 81003-1929 | 2006-12-01 |
| 1588223598 | Chelsea L Frey | Nurse Practitioner | 1310 Fortino Blvd Ste D, Pueblo, CO 81008-2076 | 2019-06-12 |
| 1477002020 | Nathan Gasper | Nurse Practitioner | 1919 W Us Highway 50, Pueblo, CO 81008 | 2016-09-23 |
| 1528211760 | Pamela Isley | Nurse Practitioner | 3426 Lake Ave, #120, Pueblo, CO 81004-3877 | 2008-10-31 |
| 1144361072 | Beatrice Gagliardi | Nurse Practitioner | 3676 Parker Blvd, Pueblo, CO 81008-2212 | 2007-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770190415 | Brittany Delmonico | Nurse Practitioner | 5224 Coralberry Ct, Fort Collins, CO 80525-5506 | 2020-09-27 |
| 1649884461 | Jenna Dalton Kuhl | Nurse Practitioner | 5 S Pearl St, Denver, CO 80209-2013 | 2020-08-31 |
| 1235747809 | Megan Gottsch | Nurse Practitioner | 1838 E 33rd Ave, Denver, CO 80205-4057 | 2020-07-20 |
| 1497363196 | Grace A Worland | Nurse Practitioner | 1065 Jade St, Broomfield, CO 80020-1862 | 2020-07-19 |
| 1477171247 | Emily Hull-lierheimer | Nurse Practitioner | 4755 Timber Wolf Trl, Colorado Springs, CO 80920-7671 | 2020-07-08 |
| 1710524137 | Julie Esther Ayaad | Nurse Practitioner | 1427 W Rio Grande, Colorado Springs, CO 80905 | 2019-12-04 |
| 1053953521 | Jason Rogers | Nurse Practitioner | 11988 Black Hawk Dr, Conifer, CO 80433-7140 | 2019-10-16 |
| 1598306623 | Minnie Nguyen Chau | Nurse Practitioner | 12605 E 16th Ave Fl 1, Aurora, CO 80045-2545 | 2019-09-30 |
| 1841841681 | Larry Vo | Nurse Practitioner | 12631 E 17th Ave Bldg Ao1, Aurora, CO 80045-2527 | 2019-09-23 |
| 1679121016 | Gwendolyn Eshie Elango | Nurse Practitioner | 21427 E Ottawa Cir, Aurora, CO 80016-2658 | 2019-08-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.