Healthcare Provider Details

I. General information

NPI: 1366741993
Provider Name (Legal Business Name): NIKKI ELIZABETH YOURSHAW M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKKI ELIZABETH WALDSTEIN M.D., MPH

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 E 14TH ST
WINSTON SALEM NC
27105-6804
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-8860
  • Fax: 336-713-8862
Mailing address:
  • Phone: 336-716-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD451556
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTL37991
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025-00521
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: