DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Waller, David Kirk	DOIID	1017526	NAIC NPN	18752189

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	10/31/2018	11/30/2022
Inactive	Non Resident	Agent	Life	10/31/2018	11/30/2022
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Financial Security Life Insurance Co.	301635	Agent - Health	7/17/2019	11/30/2022
Inactive	Anthem Life Insurance Company	301209	Agent - Health	11/3/2018	11/30/2022
Inactive	Anthem Life Insurance Company	301209	Agent - Life	11/3/2018	11/30/2022
Inactive	Aspen American Insurance Company	301513	Agent - Health	9/18/2020	12/14/2020
Inactive	CareSource Kentucky Co.	838179	Agent - Health	1/12/2022	12/13/2022
Inactive	Golden Rule Insurance Company	301943	Agent - Health	1/22/2019	12/6/2022
Inactive	Golden Rule Insurance Company	301943	Agent - Life	1/22/2019	12/6/2022
Inactive	LifeShield National Insurance Company	737111	Agent - Health	11/19/2018	12/21/2021
Inactive	Molina Healthcare of Kentucky, Inc.	1035856	Agent - Health	1/14/2022	11/30/2022
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	11/21/2018	11/22/2022
Inactive	WellCare Health Plans of Kentucky, Inc.	838592	Agent - Health	1/17/2022	11/30/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	11/5/2018	11/30/2022
Inactive	Designated Agent Company Inc.	681257	Agent - Health	11/5/2018	11/30/2022
Inactive	Health Plan Intermediaries Holdings	786463	Agent - Health	4/16/2019	4/28/2022