DEPARTMENT OF INSURANCE
Affiliations
NameNational Service Group Of Amerilife LLCDOIID715342NAIC NPN14203513
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
ActiveNon ResidentAgentHealth10/9/2009 3/31/2025
ActiveNon ResidentAgentLife10/9/2009 3/31/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.
License Renewal Information
ClassInvoice DateResponse Due / Expiration DateResponse Received DatePayment Received DateRenewal Complete
Agent01/15/202503/31/2025   
Appointments with the following Insurers
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
ActiveAccendo Insurance Company300312Agent - Life6/10/2020 
ActiveAetna Health Inc. (PA)660717Agent - Health8/14/2012 
ActiveAetna Health of Ohio Inc.1065035Agent - Health7/29/2020 
ActiveAetna Life Insurance Company301140Agent - Health8/14/2012 
ActiveAetna Life Insurance Company301140Agent - Life8/14/2012 
ActiveAmerican General Life Insurance Company301585Agent - Health4/14/2015 
ActiveAmerican General Life Insurance Company301585Agent - Life4/14/2015 
ActiveAmerican Life & Security Corp1055058Agent - Life7/14/2023 
InactiveAmerican National Insurance Company301861Agent - Health10/25/20106/3/2021
InactiveAmerican Retirement Life Insurance Company706303Agent - Health2/21/201312/23/2022
ActiveAmeritas Life Insurance Corporation300126Agent - Health9/23/2018 
ActiveAnthem Health Plans of Kentucky, Inc.300999Agent - Health6/8/2022 
ActiveAnthem Health Plans of New Hampshire, Inc.944064Agent - Health9/23/2021 
ActiveAnthem Insurance Companies, Inc.300941Agent - Health10/14/2021 
InactiveAnthem Life Insurance Company301209Agent - Health10/4/20193/25/2021
InactiveAnthem Life Insurance Company301209Agent - Life10/4/20193/25/2021
ActiveArcadian Health Plan, Inc.728196Agent - Health10/17/2017 
ActiveBankers Fidelity Assurance Company554627Agent - Health8/3/2021 
ActiveBankers Fidelity Assurance Company554627Agent - Life8/3/2021 
ActiveBankers Fidelity Life Insurance Company300193Agent - Health8/3/2021 
ActiveBankers Fidelity Life Insurance Company300193Agent - Life8/3/2021 
InactiveBankers Life Insurance Company301784Agent - Life3/28/20142/8/2019
ActiveCIGNA Health & Life Insurance Company301783Agent - Health6/13/2023 
InactiveCIGNA Health & Life Insurance Company301783Agent - Life10/28/201612/27/2022
ActiveChesapeake Life Insurance Company (The)301017Agent - Health1/25/2019 
ActiveChesapeake Life Insurance Company (The)301017Agent - Life1/25/2019 
ActiveCigna National Health Insurance Company300235Agent - Health4/21/2022 
InactiveCompBenefits Dental, Inc.591692Agent - Health7/20/20123/14/2019
ActiveCompBenefits Insurance Company301864Agent - Health1/2/2020 
ActiveCompcare Health Services Insurance Corporation948751Agent - Health9/25/2021 
ActiveContinental Life Insurance Company of Brentwood Tennessee301526Agent - Health3/6/2018 
ActiveDental Concern Inc. (The)301641Agent - Health7/20/2012 
ActiveFidelity & Guaranty Life Insurance Company301359Agent - Life3/28/2023 
ActiveFidelity Security Life Insurance Company300466Agent - Health9/22/2014 
ActiveFidelity Security Life Insurance Company300466Agent - Life9/22/2014 
ActiveGerber Life Insurance Company300529Agent - Health5/19/2013 
ActiveGerber Life Insurance Company300529Agent - Life5/19/2013 
ActiveGlobe Life and Accident Insurance Company300639Agent - Health6/11/2020 
ActiveGlobe Life and Accident Insurance Company300639Agent - Life6/11/2020 
ActiveGolden Rule Insurance Company301943Agent - Health9/3/2013 
ActiveGolden Rule Insurance Company301943Agent - Life9/3/2013 
ActiveGreat Western Insurance Company501693Agent - Life10/4/2023 
ActiveGuaranty Income Life Insurance Company552451Agent - Health4/19/2022 
ActiveGuaranty Income Life Insurance Company552451Agent - Life4/19/2022 
ActiveHumana Benefit Plan of Illinois, Inc.781543Agent - Health10/24/2014 
ActiveHumana Health Plan of Ohio Inc.301565Agent - Health4/15/2019 
ActiveHumana Health Plan, Inc.300142Agent - Health7/20/2012 
ActiveHumana Insurance Company301104Agent - Health7/13/2012 
ActiveHumana Insurance Company301104Agent - Life7/13/2012 
ActiveHumana Insurance Company of Kentucky300826Agent - Health7/20/2012 
ActiveHumana Insurance Company of Kentucky300826Agent - Life7/20/2012 
ActiveHumana Medical Plan, Inc.801568Agent - Health6/25/2015 
ActiveHumana Wisconsin Health Organization Insurance Corporation830687Agent - Health12/1/2016 
InactiveLifeShield National Insurance Company737111Agent - Life12/2/20141/5/2016
ActiveLoyal American Life Insurance Company301172Agent - Health7/22/2014 
ActiveLoyal American Life Insurance Company301172Agent - Life7/22/2014 
ActiveLumico Life Insurance Company300354Agent - Life8/2/2020 
InactiveMedico Corp Life Insurance Company301777Agent - Health2/12/20152/13/2015
InactiveMedico Corp Life Insurance Company301777Agent - Life2/12/20152/13/2015
ActiveMolina Healthcare of Kentucky, Inc.1035856Agent - Health8/9/2023 
ActiveNational Security Insurance Company1282495Agent - Life1/16/2024 
ActiveNational Western Life Insurance Company301515Agent - Life2/21/2011 
ActiveNationwide Life Insurance Company300495Agent - Health2/27/2019 
ActiveNationwide Life Insurance Company300495Agent - Life2/27/2019 
ActiveNationwide Life and Annuity Insurance Company300714Agent - Health5/13/2016 
ActiveNationwide Life and Annuity Insurance Company300714Agent - Life5/13/2016 
ActiveNorth American Company for Life and Health Insurance300291Agent - Life5/26/2015 
ActiveOceanview Life and Annuity Company301868Agent - Life6/25/2020 
ActiveOhio State Life Insurance Company (The)300865Agent - Health2/24/2020 
ActiveOhio State Life Insurance Company (The)300865Agent - Life2/24/2020 
InactivePacifiCare Life and Health Insurance Company301304Agent - Health8/16/201011/4/2011
ActivePacific Guardian Life Insurance Co., Ltd.1074040Agent - Life6/6/2022 
ActivePruco Life Insurance Company300954Agent - Health4/7/2022 
ActivePruco Life Insurance Company300954Agent - Life4/7/2022 
ActiveRoyal Neighbors of America301646Agent - Life11/22/2023 
ActiveSilverScript Insurance Company663526Agent - Health5/28/2015 
ActiveState Life Insurance Company301497Agent - Health2/7/2016 
ActiveState Life Insurance Company301497Agent - Life2/7/2016 
ActiveTier One Insurance Company301056Agent - Health10/24/2022 
InactiveTime Insurance Company300683Agent - Health12/11/201411/15/2019
InactiveTime Insurance Company300683Agent - Life12/11/201411/15/2019
ActiveTransamerica Life Insurance Company300571Agent - Health10/1/2020 
ActiveTransamerica Life Insurance Company300571Agent - Life12/14/2018 
InactiveTransamerica Premier Life Insurance Company300558Agent - Health4/9/201810/1/2020
InactiveTransamerica Premier Life Insurance Company300558Agent - Life4/9/201810/1/2020
InactiveUnited Teacher Associates Insurance Company300747Agent - Health6/11/201311/25/2014
InactiveUnitedHealthcare Insurance Company300946Agent - Health8/16/20106/19/2012
InactiveUnitedHealthcare of Kentucky, Ltd.301337Agent - Health8/5/20152/14/2017
InactiveUnitedHealthcare of Ohio, Inc.300493Agent - Health8/16/20106/19/2012
ActiveWashington National Insurance Company300587Agent - Health8/17/2012 
ActiveWashington National Insurance Company300587Agent - Life8/17/2012 
InactiveWellCare Health Insurance Company of Kentucky, Inc.301478Agent - Health2/23/20188/29/2022
InactiveWellCare Prescription Insurance Inc.654329Agent - Health11/24/20189/20/2022
Designated Individuals
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveGraham, Mark Burnside 638756Agent - Health4/13/20183/22/2022
InactiveGraham, Mark Burnside 638756Agent - Life4/13/20183/22/2022
ActiveGraham, Matthew B 640480Agent - Health3/22/2022 
ActiveGraham, Matthew B 640480Agent - Life3/22/2022 
InactiveNorth, Timothy Owen 514133Agent - Health10/9/20094/13/2018
InactiveNorth, Timothy Owen 514133Agent - Life10/9/20094/13/2018

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