Healthcare Provider Details

I. General information

NPI: 1366386799
Provider Name (Legal Business Name): PROGRESSIVE PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14903 SANDSTONE DR
FORT WAYNE IN
46814-8888
US

IV. Provider business mailing address

429 E DUPONT RD # 1064
FORT WAYNE IN
46825-2051
US

V. Phone/Fax

Practice location:
  • Phone: 260-249-0409
  • Fax:
Mailing address:
  • Phone: 260-249-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA E AGUNANNE
Title or Position: MEMBER
Credential: DNP
Phone: 260-249-0409