DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Keithley, Michael Donovan	DOIID	825228	NAIC NPN	17085715

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	7/25/2024		11/30/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	09/15/2025	11/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	8/1/2024
Active	CareSource Kentucky Co.	838179	Agent - Health	8/22/2024
Active	Molina Healthcare of Kentucky, Inc.	1035856	Agent - Health	8/5/2024
Active	WellCare Health Plans of Kentucky, Inc.	838592	Agent - Health	8/5/2024

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	11/26/2013	11/30/2017