DEPARTMENT OF INSURANCE

Affiliations

Name	Waller, Brent William	DOIID	763512	NAIC NPN	16383639

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	9/17/2021	2/28/2023
Inactive	Non Resident	Agent	Life	9/14/2011	3/7/2016
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	10/1/2012	3/7/2016
Inactive	Aetna Health Insurance Company	301583	Agent - Health	8/22/2014	3/7/2016
Inactive	Aetna Life Insurance Company	301140	Agent - Health	10/1/2012	3/7/2016
Inactive	Aetna Life Insurance Company	301140	Agent - Life	10/1/2012	3/7/2016
Inactive	American Continental Insurance Company	643130	Agent - Health	9/24/2012	2/17/2014
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	9/17/2021	5/16/2022
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	9/30/2021	5/16/2022
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/17/2021	5/16/2022
Inactive	Anthem Life Insurance Company	301209	Agent - Health	9/10/2014	4/1/2015
Inactive	Anthem Life Insurance Company	301209	Agent - Life	9/10/2014	4/1/2015
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	8/9/2012	3/4/2014
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/17/2021	5/16/2022
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	7/31/2012	1/28/2013
Inactive	Connecticut General Life Insurance Company	301333	Agent - Life	7/31/2012	1/28/2013
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	9/8/2014	11/6/2014
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	8/22/2014	3/7/2016
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	9/8/2014	11/6/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/8/2014	11/6/2014
Inactive	Humana Insurance Company	301104	Agent - Health	9/8/2014	11/6/2014
Inactive	Humana Insurance Company	301104	Agent - Life	9/8/2014	11/6/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/8/2014	11/6/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/8/2014	11/6/2014
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/30/2013	3/4/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/30/2013	3/4/2014
Inactive	Loyal American Life Insurance Company	301172	Agent - Health	8/16/2014	7/10/2015
Inactive	Loyal American Life Insurance Company	301172	Agent - Life	8/16/2014	7/10/2015
Inactive	Medco Containment Life Insurance Company	301557	Agent - Health	9/12/2012	7/7/2015
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Health	10/7/2011	2/27/2012
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Life	10/7/2011	2/27/2012
Inactive	SilverScript Insurance Company	663526	Agent - Health	10/3/2012	2/18/2015
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/7/2014	10/30/2014
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	8/7/2014	10/30/2014
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	11/25/2013	2/4/2015

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 - Health	8/13/2012	3/7/2016
Inactive	Designated Agent Company Inc.	681257	Agent - Life	9/10/2014	3/7/2016