Healthcare Provider Details

I. General information

NPI: 1588197743
Provider Name (Legal Business Name): KRISTINA THERESA ACEVEDO M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date: 11/09/2017
Reactivation Date: 11/14/2017

III. Provider practice location address

929 N ST FRANCIS ST
WICHITA KS
67214-3821
US

IV. Provider business mailing address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-5000
  • Fax: 816-302-9939
Mailing address:
  • Phone: 816-701-5200
  • Fax: 816-302-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number04-47786
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: