Raven Custalow, AGPCNP-BC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0024176579 Issued in VA

Practice address

7864 Richmond Tappahannock Hwy
Aylett, VA 23009-3056

Phone

(804) 769-2015

NPI assigned

Sep 12, 2018

Last updated

Oct 15, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Georgetown University School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Upper Mattaponi Indian TribeGroup PAC ID 4880091446, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vcu Health Tappahannock Hospital Hospital, Tappahannock, VA, CCN 490084
• Bon Secours Memorial Regional Medical Center Hospital, Mechanicsville, VA, CCN 490069

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Upper Mattaponi Indian Tribe

  dba Aylett Family Wellness

  • Primary Care Clinic/Center
  • Aylett, VA
  • NPI 1750969168

  Family Medicine, TX

  Medicare reassignment Care Compare group NPD
• Upper Mattaponi Indian Tribe

  dba Aylett Family Dentistry

  • Dental Clinic/Center
  • Aylett, VA
  • NPI 1245098391
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bon Secours Memorial Regional Medical Center LLC

  dba Memorial Regional Medical Center

  • General Acute Care Hospital
  • Mechanicsville, VA
  • NPI 1912969064
  Care Compare affiliation
• Vcu Health Tappahannock Hospital

  • General Acute Care Hospital
  • Tappahannock, VA
  • NPI 1760580757
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792022400000",
    "number": "1669955019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3944 UPSHAW RD",
            "city": "AYLETT",
            "state": "VA",
            "postal_code": "230092912",
            "telephone_number": "804-928-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7864 RICHMOND TAPPAHANNOCK HWY",
            "city": "AYLETT",
            "state": "VA",
            "postal_code": "230093056",
            "telephone_number": "804-769-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTALOW",
        "first_name": "RAVEN",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-12",
        "last_updated": "2026-10-15",
        "certification_date": "2026-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0024176579",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "VA",
            "license": "0024176579",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samone Boyd
• Latricia Broaddus
• Lily Alemi Cameron, MD
• Central Virginia Health Services Inc (CVHS King William)
• Joanne Lynne Cunningham
• Jessica D'Aurora, PHARMD
• Faithhopelove, LLC
• Andrea Garrett, NP
• Christina Barrett Hawkins, MD, MPH
• Its All About Caring LLC

• Family Medicine Physician in Aylett, VA
• Providers in Aylett, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.