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DEPARTMENT OF INSURANCE
Affiliations
Name
Sample, Mandy
DOIID
898574
NAIC NPN
17774363
License - Line of Authority Information
Status
Residency
Class
Line of Authority
Active Date
Inactive Date
License Expiration Date
Active
Resident
Agent
Health
11/19/2015
4/30/2025
Active
Resident
Agent
Life
11/19/2015
4/30/2025
* 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
American United Life Insurance Company
300498
Agent - Health
1/11/2017
9/29/2023
Inactive
American United Life Insurance Company
300498
Agent - Life
1/11/2017
9/29/2023
Active
Anthem Life Insurance Company
301209
Agent - Health
1/25/2017
Active
Anthem Life Insurance Company
301209
Agent - Life
1/25/2017
Designated to act on behalf of the following Business Entities
Status
Affiliation Name
DOI Number
Line of Authority
Active Date
Inactive Date
Active
Designated Agent Company Inc.
681257
Agent - Life
1/26/2017
Active
Designated Agent Company Inc.
681257
Agent - Health
1/26/2017
Inactive
Kentucky Hospital Service Company of Kentucky, LLC
401254
Agent - Life
1/25/2017
2/23/2018
Inactive
Kentucky Hospital Service Company of Kentucky, LLC
401254
Agent - Health
1/25/2017
2/23/2018
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