NICOLE LYNN ACKLEY, Physician Assistant — NPI 1265532337 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical in BOISE, ID)

CMS-1500 Box 24J / 33a • NPI

1265532337

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363AM0700X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical

Box 32 Service Location & ZIP+4

500 W FORT ST, BOISE, ID, 83702-4501

✓ 9-Digit EDI 837 ZIP+4 (83702-4501)

Practice Phone & Referral Fax

(208) 422-1000

Fax: (208) 422-1265

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1265532337 (NICOLE LYNN ACKLEY, Physician Assistant) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1265532337` (NPI-1 Individual Practitioner)
Provider / Legal Name	NICOLE LYNN ACKLEY, Physician Assistant
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical NUCC Code: `363AM0700X` (Physician Assistant, Medical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	500 W FORT ST, BOISE, ID, 83702-4501
Practice Telephone / Fax	Tel: (208) 422-1000 \| Fax: (208) 422-1265
Administrative Mailing Address	1466 N TRAIL CREEK WAY, EAGLE, ID, 83616-4090
Enumeration & Last Sync	Enumerated: 2006-09-25 \| CMS Record Updated: 2007-07-08

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

500 W FORT ST, BOISE, ID, 83702-4501

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Plain-English Taxonomy & CMS Crosswalk (363AM0700X)

What Does Taxonomy Code 363AM0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363AM0700X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant, Medical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (NICOLE LYNN ACKLEY, Physician Assistant)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363AM0700X` — Physician Assistant, Medical Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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NICOLE LYNN ACKLEY, Physician Assistant (NPI #1265532337)