RAVEN CUSTALOW AGPCNP-BC NPI 1669955019

NPI Information

  • NPI: 1669955019
  • Provider Name: RAVEN CUSTALOW, AGPCNP-BC
  • Classification: Nurse Practitioner - 363LP2300X
  • Specialization: Primary Care
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 7864 RICHMOND TAPPAHANNOCK HWY
    AYLETT, VA
    ZIP 23009
  • Phone: (804) 769-2015

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NPI Details

Raven Custalow, AGPCNP-BC is a primary care nurse practitioner in Aylett, VA with 8 years of experience. Raven Custalow, AGPCNP-BC NPI is 1669955019. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2018

The provider's business location address is:

7864 RICHMOND TAPPAHANNOCK HWY
AYLETT, VA
ZIP 23009-056
Phone: (804) 769-2015

The NPI 1669955019 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/12/2018 and was last updated on 11/8/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP2300XNurse PractitionerPrimary Care0024176579VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13001529971MEDICAIDVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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