Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Raven Custalow, AGPCNP-BC

Individual provider Primary Care Nurse Practitioner · NPI 1669955019

Raven Custalow, AGPCNP-BC is a Nurse Practitioner in Aylett, Virginia. Graduated from Georgetown University School of Medicine in 2018, 8 years ago. Practices with Upper Mattaponi Indian Tribe, a 5-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
8
Trained at
Georgetown University School of Medicine
Licensed in
VA
In the registry since
2018

Practice location Address checks out

7864 Richmond Tappahannock Hwy
Aylett, VA 23009-3056
Phone: (804) 769-2015
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence 0024176579 (VA)

Record details

NPI number1669955019
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGPCNP-BC
Sole proprietorNo
NPI enumeratedSeptember 12, 2018
Last updated in NPPESNovember 8, 2024
Certification dateNovember 8, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolGEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
Graduated 2018 (8 years in practice)
Group practice Upper Mattaponi Indian Tribe — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Aylett