# SOCO PRIMARY CARE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124677729
- **Authorized official:** NICOLE LYNN BETTS NP, AGNP-C (PRESIDENT, AUTHORIZED OFFICIAL)
- **Authorized official phone:** (719) 582-1898

## Contact information

- **Practice address:** 1310 FORTINO BLVD STE D, PUEBLO, CO 81008-2076
- **Practice address phone:** (719) 582-1898
- **Practice address fax:** (719) 621-4098
- **Mailing address:** 1310 FORTINO BLVD, PUEBLO, CO 81008-2075

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/06/2019
- **Last updated:** 04/30/2020