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DEPARTMENT OF INSURANCE
Affiliations
Name
Fuller Jr, David A
DOIID
390618
NAIC NPN
759367
License - Line of Authority Information
Status
Residency
Class
Line of Authority
Active Date
Inactive Date
License Expiration Date
Active
Non Resident
Agent
Life
10/18/1996
4/30/2027
Active
Non Resident
Agent
Health
10/18/1996
4/30/2027
Active
Non Resident
Agent
Variable Life and Variable Annuities
5/31/2001
4/30/2027
Inactive
Non Resident
Agent
Health Maintenance Organization
9/23/1999
3/1/2001
* If a status Is
Pending, Pending Replacement
,Or the record displays
Affidavit On File
, click On them For more details.
Notice:
The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.
License Renewal Information
Class
Invoice Date
Response Due / Expiration Date
Response Received Date
Payment Received Date
Renewal Complete
Agent
02/15/2025
04/30/2025
03/04/2025
03/04/2025
Yes
Appointments with the following Insurers
Status
Affiliation Name
DOI Number
Line of Authority
Active Date
Inactive Date
Inactive
American General Life Insurance Company
301585
Agent - Health
6/24/2003
10/20/2011
Inactive
American General Life Insurance Company
301585
Agent - Life
6/24/2003
10/20/2011
Inactive
American General Life Insurance Company
301585
Agent - Variable Life and Variable Annuities
6/24/2003
1/14/2022
Inactive
American Heritage Life Insurance Company
300272
Agent - Health
11/7/2012
1/23/2013
Inactive
American Heritage Life Insurance Company
300272
Agent - Life
11/7/2012
1/23/2013
Active
American United Life Insurance Company
300498
Agent - Health
12/13/1999
Active
American United Life Insurance Company
300498
Agent - Life
12/13/1999
Active
Anthem Health Plans of Kentucky, Inc.
300999
Agent - Health
1/31/2025
Inactive
Athene Annuity & Life Assurance Company
301798
Agent - Health
4/11/2007
8/3/2010
Inactive
Athene Annuity & Life Assurance Company
301798
Agent - Life
4/11/2007
8/3/2010
Active
Banner Life Insurance Company
301696
Agent - Life
7/6/2016
Inactive
Berkshire Life Insurance Company of America
300983
Agent - Health
1/22/2004
9/16/2013
Inactive
Berkshire Life Insurance Company of America
300983
Agent - Life
1/22/2004
9/16/2013
Inactive
C.M. Life Insurance Company
301335
Agent - Health
10/21/1999
3/18/2009
Inactive
C.M. Life Insurance Company
301335
Agent - Life
10/21/1999
3/18/2009
Inactive
C.M. Life Insurance Company
301335
Agent - Variable Life and Variable Annuities
5/28/2002
3/18/2009
Active
CIGNA Health & Life Insurance Company
301783
Agent - Health
12/21/2023
Inactive
Clarica Life Insurance Company - U.S.
300207
Agent - Life
5/16/2002
4/26/2004
Inactive
CompBenefits Dental, Inc.
591692
Agent - Health
3/25/2014
12/5/2014
Inactive
CompBenefits Insurance Company
301864
Agent - Health
6/25/2020
12/15/2020
Inactive
CompBenefits Insurance Company
301864
Agent - Life
5/7/2010
12/5/2011
Inactive
Dental Concern Inc. (The)
301641
Agent - Health
5/13/2020
12/15/2020
Inactive
Equitable Financial Life Insurance Company
300808
Agent - Life
4/24/2008
12/10/2010
Inactive
Equitable Financial Life Insurance Company
300808
Agent - Variable Life and Variable Annuities
4/24/2008
12/10/2010
Inactive
First Colony Life Insurance Company
301179
Agent - Life
7/16/2001
1/1/2007
Inactive
Genworth Life and Annuity Insurance Company
301276
Agent - Health
4/24/2009
12/7/2012
Inactive
Genworth Life and Annuity Insurance Company
301276
Agent - Life
1/1/2007
12/7/2012
Active
Guardian Life Insurance Company of America
301316
Agent - Health
1/22/2004
Active
Guardian Life Insurance Company of America
301316
Agent - Life
1/22/2004
Active
Hartford Life and Accident Insurance Company
300878
Agent - Health
3/5/2007
Active
Hartford Life and Accident Insurance Company
300878
Agent - Life
3/5/2007
Inactive
Humana Benefit Plan of Illinois, Inc.
781543
Agent - Health
6/25/2020
12/15/2020
Inactive
Humana Health Plan of Ohio Inc.
301565
Agent - Health
6/25/2020
12/15/2020
Inactive
Humana Health Plan, Inc.
300142
Agent - Health
5/13/2020
12/12/2024
Inactive
Humana Health Plan, Inc.
300142
Agent - Health Maintenance Organization
9/23/1999
3/1/2001
Inactive
Humana Insurance Company
301104
Agent - Health
11/8/2021
12/12/2024
Inactive
Humana Insurance Company
301104
Agent - Life
12/17/2018
12/19/2019
Inactive
Humana Insurance Company of Kentucky
300826
Agent - Health
4/14/2017
4/8/2020
Inactive
Humana Insurance Company of Kentucky
300826
Agent - Life
5/13/2020
12/15/2020
Inactive
Humana Medical Plan, Inc.
801568
Agent - Health
6/25/2020
12/15/2020
Inactive
Humana Wisconsin Health Organization Insurance Corporation
830687
Agent - Health
6/25/2020
12/15/2020
Inactive
HumanaDental Insurance Company
301457
Agent - Health
6/3/2002
2/24/2012
Inactive
Illinois Mutual Life Insurance Company
301479
Agent - Health
1/10/1997
6/17/1999
Inactive
Illinois Mutual Life Insurance Company
301479
Agent - Life
1/10/1997
6/17/1999
Inactive
John Alden Life Insurance Company
300573
Agent - Health
8/28/2000
6/3/2002
Inactive
John Alden Life Insurance Company
300573
Agent - Life
8/28/2000
6/3/2002
Inactive
Kanawha Insurance Company
300127
Agent - Health
3/25/2014
12/5/2014
Inactive
Kanawha Insurance Company
300127
Agent - Life
3/25/2014
12/5/2014
Active
Life Insurance Company of North America
300711
Agent - Health
1/14/2019
Active
Life Insurance Company of North America
300711
Agent - Life
9/29/2014
Active
Life Insurance Company of North America
300711
Agent - Variable Life and Variable Annuities
6/17/2021
Inactive
Lincoln Benefit Life Company
301110
Agent - Health
5/16/2006
7/14/2014
Inactive
Lincoln Benefit Life Company
301110
Agent - Life
5/16/2006
7/14/2014
Inactive
Lincoln Benefit Life Company
301110
Agent - Variable Life and Variable Annuities
5/16/2006
7/14/2014
Active
Lincoln National Life Insurance Company (The)
301382
Agent - Health
6/29/2007
Active
Lincoln National Life Insurance Company (The)
301382
Agent - Life
6/29/2007
Inactive
Lincoln National Life Insurance Company (The)
301382
Agent - Variable Life and Variable Annuities
6/29/2007
6/12/2015
Inactive
MML Bay State Life Insurance Company
301198
Agent - Health
10/21/1999
5/28/2002
Inactive
MML Bay State Life Insurance Company
301198
Agent - Life
10/21/1999
5/28/2002
Inactive
Massachusetts Mutual Life Insurance Company
300445
Agent - Health
10/21/1999
3/18/2009
Inactive
Massachusetts Mutual Life Insurance Company
300445
Agent - Life
10/21/1999
3/18/2009
Inactive
Massachusetts Mutual Life Insurance Company
300445
Agent - Variable Life and Variable Annuities
5/31/2001
3/18/2009
Inactive
Midland National Life Insurance Company
300923
Agent - Life
4/26/2004
3/9/2005
Inactive
Northwestern Mutual Life Insurance Company
300931
Agent - Health
10/18/1996
2/8/1999
Inactive
Northwestern Mutual Life Insurance Company
300931
Agent - Life
10/18/1996
2/8/1999
Inactive
PartnerRe Life Reinsurance Company of America
300550
Agent - Health
4/25/2002
11/7/2011
Inactive
Paul Revere Life Insurance Company
300971
Agent - Health
11/21/1996
6/17/1999
Inactive
Paul Revere Life Insurance Company
300971
Agent - Life
11/21/1996
6/17/1999
Active
Principal Life Insurance Company
300129
Agent - Health
12/4/1999
Active
Principal Life Insurance Company
300129
Agent - Life
12/4/1999
Inactive
Principal Life Insurance Company
300129
Agent - Variable Life and Variable Annuities
5/31/2001
3/25/2011
Inactive
Provident Life and Accident Insurance Company
301525
Agent - Health
6/18/2010
9/9/2015
Inactive
Provident Life and Accident Insurance Company
301525
Agent - Life
6/18/2010
9/9/2015
Inactive
Reassure America Life Insurance Company
301902
Agent - Health
3/20/2000
9/3/2004
Inactive
Reassure America Life Insurance Company
301902
Agent - Life
3/20/2000
9/3/2004
Active
Sun Life Assurance Company of Canada
301811
Agent - Health
5/1/2020
Active
Sun Life Assurance Company of Canada
301811
Agent - Life
5/1/2020
Pending Replacement
Superior Dental Care Inc.
300418
Agent - Health
1/28/2011
Active
Symetra Life Insurance Company
301691
Agent - Health
10/29/2018
Active
Symetra Life Insurance Company
301691
Agent - Life
10/29/2018
Active
Symetra Life Insurance Company
301691
Agent - Variable Life and Variable Annuities
10/29/2018
Inactive
UNUM Life Insurance Company of America
300817
Agent - Health
6/18/2010
9/9/2015
Inactive
UNUM Life Insurance Company of America
300817
Agent - Life
6/18/2010
9/9/2015
Inactive
Union Security Insurance Company
301844
Agent - Health
6/24/2002
12/19/2012
Inactive
Union Security Insurance Company
301844
Agent - Life
6/24/2002
12/19/2012
Inactive
United Heartland Life Insurance Company
517547
Agent - Health
12/27/2001
7/31/2006
Inactive
United Heartland Life Insurance Company
517547
Agent - Life
12/27/2001
7/31/2006
Inactive
United Wisconsin Insurance Company
301103
Agent - Health
12/27/2001
7/31/2006
Active
United of Omaha Life Insurance Company
300156
Agent - Health
11/18/2002
Active
United of Omaha Life Insurance Company
300156
Agent - Life
11/18/2002
Active
United of Omaha Life Insurance Company
300156
Agent - Variable Life and Variable Annuities
3/7/2024
Inactive
UnitedHealthcare Insurance Company
300946
Agent - Health
11/20/2012
11/30/2016
Inactive
UnitedHealthcare Insurance Company
300946
Agent - Life
11/20/2012
11/30/2016
Inactive
UnitedHealthcare of Kentucky, Ltd.
301337
Agent - Health
11/20/2012
11/30/2016
Inactive
UnitedHealthcare of Ohio, Inc.
300493
Agent - Health
11/20/2012
11/30/2016
Designated to act on behalf of the following Business Entities
Status
Affiliation Name
DOI Number
Line of Authority
Active Date
Inactive Date
Active
Assuredpartners NL, LLC
762387
Agent - Life
9/21/2011
Active
Assuredpartners NL, LLC
762387
Agent - Health
9/21/2011
Inactive
Assuredpartners NL, LLC
762387
Agent - Variable Life and Variable Annuities
9/21/2011
10/16/2011
Inactive
Dental Choice Agency Inc.
398085
Agent - Health
4/13/2009
7/21/2014
Inactive
Designated Agent Company Inc.
681257
Agent - Life
12/6/2013
2/13/2025
Inactive
Designated Agent Company Inc.
681257
Agent - Health
12/6/2013
2/13/2025
Inactive
Neace & Associates Insurance Agency of OH, Inc.
521908
Agent - Life
2/11/2005
3/31/2013
Inactive
Neace & Associates Insurance Agency of OH, Inc.
521908
Agent - Health
2/11/2005
3/31/2013
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