MEDICARE: NURSE KAYSHA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1811849979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSE KAYSHA LLC

Provider Business Mailing Address
First Line	:	540 W KINGS HWY
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-9298
Country	:	US
Telephone Number	:	307-249-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 W KINGS HWY
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-9298
Country	:	US
Telephone Number	:	307-249-6674
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. KAYSHA RAELYNNE HENGELFELT
Credential	:	RN
Telephone Number	:	307-249-6674

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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