DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Petersen, Tara M	DOIID	1360666	NAIC NPN	21303652

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	9/10/2024		12/31/2025
* 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	10/15/2025	12/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aetna Health Inc. (PA)	660717	Agent - Health	9/18/2024
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	9/18/2024
Active	Aetna Life Insurance Company	301140	Agent - Health	9/18/2024
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	9/29/2024	2/6/2025
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/29/2024	2/6/2025
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/29/2024	2/6/2025
Inactive	Molina Healthcare of Kentucky, Inc.	1035856	Agent - Health	9/19/2024	1/16/2025
Active	SilverScript Insurance Company	663526	Agent - Health	9/18/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	eHealthInsurance Services Inc.	514105	Agent - Health	11/11/2024	12/13/2024