Healthcare Provider Details

I. General information

NPI: 1265963706
Provider Name (Legal Business Name): LAUREN STORY-HEFTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN M STORY

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 S RIFE MEDICAL LN STE 210
ROGERS AR
72758-1456
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3888
  • Fax: 479-338-4453
Mailing address:
  • Phone: 479-338-3888
  • Fax: 479-338-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberE-15577
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberE-15577
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: