DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Johnson, Petagay	DOIID	927559	NAIC NPN	18061005

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	9/1/2016		5/31/2027
* 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	03/15/2025	05/31/2025	04/16/2025	04/16/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arcadian Health Plan, Inc.	728196	Agent - Health	10/11/2017	12/19/2017
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/21/2022
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	9/6/2016	12/19/2017
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	9/6/2016	12/19/2017
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	9/6/2016	12/19/2017
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/6/2016	12/19/2017
Inactive	Humana Insurance Company	301104	Agent - Health	9/6/2016	12/19/2017
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/6/2016	12/19/2017
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	9/6/2016	12/19/2017
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/12/2016	12/19/2017
Active	Sierra Health and Life Insurance Company Inc.	300357	Agent - Health	8/24/2022
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	4/29/2018
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	4/29/2018	12/21/2018
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/6/2019	12/22/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/15/2018	12/23/2021
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	4/29/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	11/21/2017	12/19/2017