1. Home
  2. Directory
  3. Colorado
  4. Pueblo
  5. Nurse Practitioner
  6. NPI Profile

SOCO PRIMARY CARE CLINIC
NPI 1124677729
Nurse Practitioner - Adult Health in Pueblo, CO

Active since September 06, 2019CLIA 06D2173237 · Waiver
1310 FORTINO BLVD STE D, PUEBLO, CO 81008(719) 582-1898(719) 621-4098 Get Directions Write a Review

NPPES record last updated: April 30, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 21, 2019, Sep 19, 2019, Sep 6, 2019 (3 updates tracked since 2019).

About Soco Primary Care Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOCO PRIMARY CARE CLINIC (NPI 1124677729) is a healthcare organization registered as an adult health in Pueblo, Colorado and active in the NPI registry since September 2019. The organization holds a CLIA Waiver certificate valid through October 7, 2027 and lists Nicole Lynn Betts, President, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1124677729
Entity TypeOrganization
Primary Taxonomy363LA2200X
Legal Business NameSOCO PRIMARY CARE CLINIC
Location Address1310 FORTINO BLVD STE DPueblo, CO 81008-2076
Mailing Address1310 Fortino BlvdPueblo, CO 81008-2075
Phone(719) 582-1898
Fax(719) 621-4098
Organization SubpartNo
Authorized OfficialNicole Lynn BettsPresident, Authorized Official · (719) 582-1898
Enumeration DateSeptember 6, 2019
Last NPPES UpdateApril 30, 20203 updates tracked since enumeration
NPPES CertifiedApril 30, 2020
✔ NPI 1124677729 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
1310 FORTINO BLVD STE D, Pueblo, CO 81008
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 06D2173237

Soco Primary Care Clinic · Pueblo, CO
Active · expires Oct 7, 2027
CLIA Number06D2173237
Laboratory TypePractitioner Other
Certificate Effective DateOctober 8, 2025
Certificate Expiration DateOctober 7, 2027
Laboratory DirectorNicole L. Betts
Laboratory Phone(719) 582-1898
Laboratory LocationSoco Primary Care Clinic1310 Fortino Blvd, Suite D, Pueblo, CO 81008
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NICOLE BETTS AGNP-C
Nurse Practitioner (Primary Care)
1310 FORTINO BLVD STE D
PUEBLO, CO 81008
Pueblo County (719) 582-1898
CHELSEA L FREY RN, MSN, NP-C
Nurse Practitioner (Primary Care)
1310 FORTINO BLVD STE D
PUEBLO, CO 81008
Pueblo County (719) 582-1898
TALK AND PLAY THERAPIES LLC
Speech-Language Pathologist
1310 FORTINO BLVD STE D
PUEBLO, CO 81008
Pueblo County (719) 251-0935
MRS. MARCELLA ANTOINETTE MASTERSON FNP-BC
Nurse Practitioner (Family)
1310 FORTINO BLVD STE D
PUEBLO, CO 81008
Pueblo County (719) 582-1898

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Soco Primary Care Clinic's NPI number?

The NPI number for Soco Primary Care Clinic is 1124677729. It was assigned to this organization in the NPPES registry on September 6, 2019.

Where is Soco Primary Care Clinic located?

Soco Primary Care Clinic is located at 1310 Fortino Blvd Ste D, Pueblo, CO 81008. The listed phone number is (719) 582-1898.

What is Soco Primary Care Clinic's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Does Soco Primary Care Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 06D2173237) is associated with this NPI, valid through October 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Soco Primary Care Clinic was last updated on April 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.