KORNNISA MCCALLON FNP
NPI 1861182115
Nurse Practitioner - Family in Apple Valley, CA
About Kornnisa Mccallon Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KORNNISA MCCALLON FNP (NPI 1861182115) is an individual family provider in Apple Valley, California, licensed in California (95023549) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 3
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kornnisa Mccallon Fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kornnisa Mccallon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Victorville, CA 92395
- Reassigned Medicare billing, California enrollment
- 145 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92307 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kornnisa Mccallon's NPI number?
The NPI number for Kornnisa Mccallon is 1861182115. It was assigned to this individual provider in the NPPES registry on May 10, 2023.
Where is Kornnisa Mccallon located?
Kornnisa Mccallon practices at 16167 Siskiyou Rd Ste A, Apple Valley, CA 92307. The listed phone number is (760) 242-2146.
What is Kornnisa Mccallon's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Kornnisa Mccallon enrolled in Medicare?
Yes. Kornnisa Mccallon is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kornnisa Mccallon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kornnisa Mccallon reassigns Medicare benefits to Desert Valley Medical Group, Inc (Victorville, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kornnisa Mccallon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kornnisa Mccallon was last updated on March 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kornnisa Mccallon, FNP · NPI 1861182115
Family physician in Apple Valley, California. Individual provider, active in the CMS NPPES registry since May 10, 2023.
## Identity
- **NPI:** 1861182115 (Entity type: Individual)
- **Enumerated:** May 10, 2023
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 95023549 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 16167 SISKIYOU RD STE A, Apple Valley, CA 92307-0837
- **Phone:** (760) 242-2146
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Desert Valley Medical Group, Inc (NPI 1952020315, Victorville, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 14, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1861182115) · Data from the CMS NPPES public registry.