Provider Demographics
NPI:1821103763
Name:KYNASTON, LINDA BURNS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:BURNS
Last Name:KYNASTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:GAIL
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1647 N ALVERNON WAY
Mailing Address - Street 2:STE 3
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-408-1499
Mailing Address - Fax:520-321-9696
Practice Address - Street 1:1647 N ALVERNON WAY
Practice Address - Street 2:STE 3
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-408-1499
Practice Address - Fax:520-321-9696
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1279103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0602640OtherBLUE CROSS
11509749OtherCAQH
2479157OtherAETNA
11509749OtherCAQH