Agency Information

REVOLT HEALTHCARE ALLIANCE, PLLC

2591 DALLAS PARKWAY

FRISCO, TX 75034

214-717-7505

contracting@revolthealthcare.com

19412020

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res. Producer Firm	3728757	09/29/2021	Active	09/29/2021	09/30/2027

Qualification Type	Original Issue Date	Status	Effective Date
Health	09/29/2021	Active	09/29/2021
Life	09/29/2021	Active	09/29/2021

Company Name	Appointment Type	Status	Active Date
523
PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY	Health	Active	11/04/2024
	Life	Active	11/04/2024

row(s) 1 - 2 of 2

Name	Association Type	Agent	Begin Date	End Date
BENTON MICHAEL JONES	Designated Resp Lic Prdcr	No	09/29/2021	-

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