Everlife Family and Functional Medicine Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

EVERLIFE FAMILY AND FUNCTIONAL MEDICINE CLINIC LLC

Practice address

1290 7TH St Ste 8
Slidell, LA 70458-2042

Phone

(985) 251-2562

NPI assigned

Sep 24, 2025

Last updated

Oct 29, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephanie Wallace, FNP-BC, FNP-CNPI 1811715493

Title

FNP/Owner

Phone

(985) 251-2562

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephanie Wallace, FNP-BC, FNP-C

  • Family Nurse Practitioner
  • Slidell, LA
  • NPI 1811715493
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761696000000",
    "number": "1295608461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 SONIAT ST",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704612819",
            "telephone_number": "985-251-2562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 7TH ST STE 8",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582042",
            "telephone_number": "985-251-2562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERLIFE FAMILY AND FUNCTIONAL MEDICINE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-24",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "FNP/OWNER",
        "authorized_official_telephone_number": "985-251-2562",
        "authorized_official_credential": "FNP-BC, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Slidell, LA
• Providers in Slidell, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.