DEPARTMENT OF INSURANCE

Name	Clark, Lisa M	DOIID	381607	NAIC NPN	1487828

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Health	12/29/2008		9/30/2026
Active	Resident	Agent	Life	12/29/2008		9/30/2026
Inactive	Resident	Agent	Health Maintenance Organization	4/29/1994	3/1/2001

*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	07/15/2024	09/30/2024	07/17/2024	07/17/2024	Yes

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	3274 Kruer Court Edgewood, KY 41017
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(513) 826-7123