Healthcare Provider Details

I. General information

NPI: 1235075680
Provider Name (Legal Business Name): LACHRYLE ASHLEY NISBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY NISBY LPN-C, LMT

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6109 W OVERLAND RD STE 102
BOISE ID
83709-3018
US

IV. Provider business mailing address

6109 W OVERLAND RD STE 102
BOISE ID
83709-3018
US

V. Phone/Fax

Practice location:
  • Phone: 208-614-4447
  • Fax:
Mailing address:
  • Phone: 208-614-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number49497
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS-5104
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: