Active NPI
Everlife Family and Functional Medicine Clinic LLC
- Family Nurse Practitioner
- Slidell, LA
National Provider Identifier
1295608461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephanie Wallace, FNP-BC, FNP-C
- Title
- FNP/Owner
- Phone
- (985) 251-2562
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | |||
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
1290 7TH St Ste 8
Slidell, LA 70458-2042
Mailing address
121 Soniat St
Slidell, LA 70461-2819
Phone (985) 251-2562
National Provider Directory
National Provider DirectoryLocations
1290 7th St
Ste 8
Slidell, LA 70458
Phone (985) 251-2562
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
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": []
}Other providers in Slidell, LA
Sources for this page
- 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.