DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Green, Theresa Dawn	DOIID	1025844	NAIC NPN	19022049

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	8/19/2021		5/31/2027
Active	Non Resident	Agent	Health	8/19/2021		5/31/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	03/15/2025	05/31/2025	04/14/2025	04/14/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Anthem Life Insurance Company	301209	Agent - Health	3/15/2019	6/19/2019
Inactive	Anthem Life Insurance Company	301209	Agent - Life	3/15/2019	6/19/2019

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	3/15/2019	6/19/2019
Inactive	Designated Agent Company Inc.	681257	Agent - Health	3/15/2019	6/19/2019
Inactive	Logan Lavelle Hunt Ins Agency LLC	398963	Agent - Life	3/15/2019	6/19/2019
Inactive	Logan Lavelle Hunt Ins Agency LLC	398963	Agent - Health	3/15/2019	6/19/2019
Denied	Shepherd Insurance, LLC	774397	Agent - Life
Denied	Shepherd Insurance, LLC	774397	Agent - Health