Provider Demographics
NPI:1679852909
Name:KYNASTON, KELLY A (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:KYNASTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 991844
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-1844
Mailing Address - Country:US
Mailing Address - Phone:530-246-9806
Mailing Address - Fax:530-246-9808
Practice Address - Street 1:2110 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2504
Practice Address - Country:US
Practice Address - Phone:530-243-1414
Practice Address - Fax:530-243-0493
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A14750207R00000X, 207RI0200X
FLUO2862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine