Provider Demographics
NPI:1588197743
Name:ACEVEDO, KRISTINA THERESA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:THERESA
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:929 N ST FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5000
Practice Address - Fax:816-302-9939
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2023-07-11
Deactivation Date:2017-11-09
Deactivation Code:
Reactivation Date:2017-11-14
Provider Licenses
StateLicense IDTaxonomies
KS04-477862080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine