DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Kelly William	DOIID	789802	NAIC NPN	8195318

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	9/8/2020		1/31/2026
Inactive	Non Resident	Agent	Life	1/4/2019	1/31/2020
* 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	Accendo Insurance Company	300312	Agent - Health	11/22/2022	11/17/2023
Active	Aetna Health Inc. (PA)	660717	Agent - Health	9/16/2020
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	11/22/2022
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	9/16/2020
Active	Aetna Life Insurance Company	301140	Agent - Health	9/16/2020
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	9/23/2019	1/31/2020
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	9/26/2021	3/5/2022
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/26/2021	3/5/2022
Inactive	Anthem Life Insurance Company	301209	Agent - Health	9/23/2019	1/31/2020
Inactive	Anthem Life Insurance Company	301209	Agent - Life	9/23/2019	1/31/2020
Active	Arcadian Health Plan, Inc.	728196	Agent - Health	1/16/2024
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	10/29/2019	1/31/2020
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Life	10/29/2019	1/31/2020
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/26/2021	3/5/2022
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	2/2/2019	1/31/2020
Active	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	2/24/2023
Active	Humana Insurance Company	301104	Agent - Health	3/20/2023
Inactive	Humana Insurance Company	301104	Agent - Life	2/15/2019	11/26/2019
Active	Humana Medical Plan, Inc.	801568	Agent - Health	11/21/2022
Inactive	Lumico Life Insurance Company	300354	Agent - Health	12/4/2019	1/31/2020
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	10/31/2020	11/22/2022
Inactive	Omaha Insurance Company	751908	Agent - Health	9/13/2012	1/31/2018
Active	SilverScript Insurance Company	663526	Agent - Health	1/11/2022
Inactive	United World Life Insurance Company	300532	Agent - Health	10/31/2020	11/22/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	10/31/2020	11/22/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	9/13/2012	7/22/2013
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/10/2020	7/25/2022
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	9/10/2020	7/25/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	9/10/2020	12/23/2021
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/10/2020	7/25/2022
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	10/11/2020	8/29/2022
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	10/10/2020	12/29/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Health Plan Intermediaries Holdings	786463	Agent - Health	12/17/2019	1/31/2020
Denied	TZ Insurance Solutions LLC	727470	Agent - Life
Inactive	TZ Insurance Solutions LLC	727470	Agent - Health	5/16/2016	1/31/2018
Active	Trubridge Inc	717747	Agent - Health	8/14/2023