DEPARTMENT OF INSURANCE

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	Health	8/19/2021		5/31/2025
Active	Non Resident	Agent	Life	8/19/2021		5/31/2025
* 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	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