Information as of 08/09/2020

Last Updated by Licensee on 03/20/2020

Kimberly Watson Lonneman PA-C
License#: 
Issue Date: 
102711
06/22/2007
License Status: 
Renewal Date:
Active  
03/22/2021  
 Public Action: Yes
 See: Actions-Adverse & Administrative Tab
Licensee General Information
Active License
Reason CodeLicense NumberSubcategoryIssue DateExpire Date
 102711PA-C06/22/2007 
Inactive License
Reason CodeLicense NumberSubcategoryIssue DateExpire Date
By Request102711PA-C02/08/199903/22/2000
Active Supervisor
SupervisorTypeStatusApproval Date
Meyer, Mitchell Dean MDActive12/04/2018
North Carolina Hospital Admitting Privileges
Out of State Active/Inactive Licenses
Illinois
Indiana
Out of Country Active/Inactive Licenses
None Reported