MEDICARE: PROGRESSIVE PSYCHIATRIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1366386799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PSYCHIATRIC SERVICES LLC

Provider Business Mailing Address
First Line	:	429 E DUPONT RD # 1064
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2051
Country	:	US
Telephone Number	:	260-249-0409
Fax Number	:

Provider Business Practice Location Address
First Line	:	14903 SANDSTONE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-8888
Country	:	US
Telephone Number	:	260-249-0409
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	CHRISTINA E AGUNANNE
Credential	:	DNP
Telephone Number	:	260-249-0409

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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