Healthcare Provider Details

I. General information

NPI: 1417327461
Provider Name (Legal Business Name): NICOLE BETTS AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 FORTINO BLVD STE D
PUEBLO CO
81008
US

IV. Provider business mailing address

1310 FORTINO BLVD STE D
PUEBLO CO
81008-2076
US

V. Phone/Fax

Practice location:
  • Phone: 719-582-1898
  • Fax: 719-621-4098
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0992247-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.0205125
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0992247-NP
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0992247-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: