black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

KEITH W. HILLER

PRODUCER NON-RESIDENT

License Number:
PRN256504
Status:
First Licensure:
09/15/2015
Cancel Date:
None

Mailing:
MOCKSVILLE, NC 27028
Phone:
+1 (336) 751-6131
Fax:
+1 (336) 751-4473
Email:
relationdoi@3hcs.com

History

License Type Start Date End Date
PRODUCER NON-RESIDENT 09/15/2015

Agency

Name Issue Date License Number Expiration Date Cancel Date
HILLER RINGEMAN INS AGENCY INC
11/24/2015 AGN260802 07/01/2023
RELATION INSURANCE SERVICES SELECT, INC.
12/29/2022 AGN374268

Employer

Name Issue Date License Number Expiration Date Cancel Date
ALLIED INSURANCE COMPANY OF AMERICA
01/01/2020 PCF216138
NATIONWIDE AFFINITY INSURANCE COMPANY OF AMERICA
10/20/2015 PCF34188 09/25/2023
NATIONWIDE ASSURANCE COMPANY
10/20/2015 PCF38952 09/25/2023
NATIONWIDE GENERAL INSURANCE COMPANY
10/20/2015 PCF30 09/25/2023
NATIONWIDE INSURANCE COMPANY OF AMERICA
10/05/2021 PCF422
NATIONWIDE MUTUAL FIRE INSURANCE COMPANY
10/20/2015 PCF31 01/01/2023
NATIONWIDE MUTUAL INSURANCE COMPANY
10/20/2015 PCF32
NATIONWIDE PROPERTY & CASUALTY INSURANCE COMPANY
10/20/2015 PCF151089 09/25/2023

Authority

Description Issue Date Termination Date Status
CASUALTY 09/15/2015 Active
PROPERTY 09/15/2015 Active

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
1154075

Other Addresses

Address Type
1109 YADKINVILLE RD
MOCKSVILLE, NC 27028-2042
Office

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 10/31/2025 08:31:54 AM