DEPARTMENT OF INSURANCE

Affiliations

Name	Provost, Shannon Noele	DOIID	543212	NAIC NPN	7223791

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Denied	Resident	Agent	Casualty
Denied	Resident	Agent	Property
Inactive	Resident	Agent	Variable Life and Variable Annuities	10/8/2004	11/1/2013
Inactive	Resident	Agent	Life	7/17/2020	10/31/2021
Inactive	Resident	Agent	Health	7/16/2020	10/31/2021
Active	Resident	Independent Adjuster	Property & Casualty	10/19/2022		10/31/2025
Denied	Resident	Temporary Agent	Casualty
Denied	Resident	Temporary Agent	Property
* 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.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Allstate Indemnity Company	300778	Agent - Casualty	5/11/2012	4/19/2013
Inactive	Allstate Indemnity Company	300778	Agent - Property	5/11/2012	4/19/2013
Inactive	Allstate Insurance Company	300773	Agent - Casualty	5/11/2012	4/19/2013
Inactive	Allstate Insurance Company	300773	Agent - Property	5/11/2012	4/19/2013
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Casualty	5/11/2012	4/19/2013
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Property	5/11/2012	4/19/2013
Inactive	American General Life and Accident Insurance Company	301362	Agent - Health	5/10/2011	5/20/2011
Inactive	American General Life and Accident Insurance Company	301362	Agent - Life	5/10/2011	5/20/2011
Inactive	Arcadian Health Plan, Inc.	728196	Agent - Health	8/31/2020	10/6/2020
Inactive	Assurity Life Insurance Company	301099	Agent - Health	8/21/2007	1/22/2009
Inactive	Assurity Life Insurance Company	301099	Agent - Life	8/21/2007	1/22/2009
Inactive	Bankers Life and Casualty Company	300701	Agent - Health	7/17/2020	9/22/2020
Inactive	Bankers Life and Casualty Company	300701	Agent - Life	7/17/2020	9/22/2020
Inactive	Colonial Penn Life Insurance Company	300491	Agent - Health	7/17/2020	9/22/2020
Inactive	Colonial Penn Life Insurance Company	300491	Agent - Life	7/17/2020	9/22/2020
Inactive	Columbian Life Insurance Company	300810	Agent - Life	2/7/2012	10/1/2012
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	3/29/2007	4/12/2011
Inactive	Everlake Life Insurance Company	300873	Agent - Health	5/18/2012	4/19/2013
Inactive	Everlake Life Insurance Company	300873	Agent - Life	5/18/2012	4/19/2013
Inactive	Everlake Life Insurance Company	300873	Agent - Variable Life and Variable Annuities	5/18/2012	4/19/2013
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	5/10/2002	12/26/2002
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	4/30/2007	11/1/2013
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	4/30/2007	11/1/2013
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	8/31/2020	10/6/2020
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	8/31/2020	10/6/2020
Inactive	Humana Insurance Company	301104	Agent - Health	8/31/2020	10/6/2020
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	8/31/2020	10/6/2020
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	8/31/2020	10/6/2020
Inactive	Independent Order of Foresters	300743	Agent - Life	3/6/2012	12/30/2013
Inactive	Life Investors Insurance Company of America	301793	Agent - Health	5/13/2002	12/26/2002
Inactive	Life Investors Insurance Company of America	301793	Agent - Life	5/13/2002	12/26/2002
Inactive	Lincoln Benefit Life Company	301110	Agent - Health	5/18/2012	4/19/2013
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	5/18/2012	4/19/2013
Inactive	Lincoln Benefit Life Company	301110	Agent - Variable Life and Variable Annuities	5/18/2012	4/19/2013
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	1/22/2002	12/26/2002
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	1/22/2002	12/26/2002
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Variable Life and Variable Annuities	3/19/2002	12/26/2002
Inactive	Middlesex Insurance Company	590568	Agent - Casualty	3/28/2007	4/13/2011
Inactive	Middlesex Insurance Company	590568	Agent - Property	3/28/2007	4/13/2011
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	2/24/2012	12/26/2012
Inactive	National Western Life Insurance Company	301515	Agent - Health	5/13/2002	12/26/2002
Inactive	National Western Life Insurance Company	301515	Agent - Life	5/13/2002	12/26/2002
Inactive	Sentry Insurance Company	300222	Agent - Casualty	3/28/2007	4/13/2011
Inactive	Sentry Insurance Company	300222	Agent - Property	3/28/2007	4/13/2011
Inactive	Sentry Life Insurance Company	301461	Agent - Health	3/28/2007	4/13/2011
Inactive	Sentry Life Insurance Company	301461	Agent - Life	3/28/2007	4/13/2011
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	2/24/2012	12/26/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	2/24/2012	12/26/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Crawford & Company	401229	Independent Adjuster - Property & Casualty	10/20/2022