NPIMap

Individual provider Active NPI

Nicole Betts, AGNP-C

  • Primary Care Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1417327461
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
APN.0992247-NP Issued in CO
Practice address
1310 Fortino Blvd Ste D
Pueblo, CO 81008
Phone
(719) 582-1898
Fax
(719) 621-4098
NPI assigned
Oct 2, 2015
Last updated
Nov 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X APN.0992247-NP CO
General Practice Registered Nurse 163WG0000X RN.0205125 CO
Gerontology Nurse Practitioner 363LG0600X APN.0992247-NP CO
Primary Care Nurse Practitioner 363LP2300X APN.0992247-NP CO Primary

Addresses

Primary practice location

1310 Fortino Blvd Ste D
Pueblo, CO 81008

Mailing address

1310 Fortino Blvd Ste D
Pueblo, CO 81008-2076

Other identifiers 1

IdentifierTypeStateIssuer
69120251MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161205002206 CO Practitioner - Nurse Practitioner 4981903911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Soco Primary Care ClinicGroup PAC ID 1759613292, 2 clinicians

Practice addresses (Care Compare)

1310 Fortino Blvd
Suite D
Pueblo, CO 81008-2076
Phone (719) 582-1898

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN.0205125COMDGeneral Practice Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Soco Primary Care Clinic Adult Health CurrentSince Oct 14, 2019 Accepting new patients

Locations

1310 Fortino Blvd
Ste D
Pueblo, CO 81008
Phone (719) 582-1898

Interoperability endpoints

  • Direct secure messaging: socoprimarycareclinicnicolebetts@145814.advancedmd-direct.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1417327461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 FORTINO BLVD STE D",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 FORTINO BLVD STE D",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "81008",
            "telephone_number": "719-582-1898",
            "fax_number": "719-621-4098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTS",
        "first_name": "NICOLE",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-02",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "APN.0992247-NP",
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CO",
            "license": "RN.0205125",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CO",
            "license": "APN.0992247-NP",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CO",
            "license": "APN.0992247-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "69120251",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.