Healthcare Provider Details

I. General information

NPI: 1376262238
Provider Name (Legal Business Name): JINKY JIREH LOMONGO WALKER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 SONG BIRD LAKES DR
GREEN COVE SPRINGS FL
32043-9314
US

IV. Provider business mailing address

3509 SONG BIRD LAKES DR
GREEN COVE SPRINGS FL
32043-9314
US

V. Phone/Fax

Practice location:
  • Phone: 904-508-4999
  • Fax:
Mailing address:
  • Phone: 904-508-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11044229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: