DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Kelly, Tyesha J	DOIID	855928	NAIC NPN	17382672

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	10/9/2014	1/31/2023
Inactive	Non Resident	Agent	Health	10/9/2014	1/31/2023
* 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	Continental American Insurance Company	301700	Agent - Health	10/30/2014	2/2/2019
Inactive	Continental American Insurance Company	301700	Agent - Life	10/30/2014	2/2/2019
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	3/10/2015	7/29/2021
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	3/10/2015	7/29/2021
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	11/10/2014	12/18/2020
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	11/10/2014	12/18/2020
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	3/10/2015	7/29/2021
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	3/10/2015	7/29/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Mercer Health & Benefits Administration LLC	656414	Agent - Life	1/15/2019	7/29/2021
Inactive	Mercer Health & Benefits Administration LLC	656414	Agent - Health	1/15/2019	7/29/2021