Raven Custalow, AGPCNP-BC
Family Medicine in Aylett, VA. Individual provider (NPI-1).
NPI number1669955019
StatusActive
Last updated in NPPESOct 15, 2026
Details
- NPI
- 1669955019
- Entity type
- Individual (NPI-1)
- Name
- Raven Custalow
- Credential
- AGPCNP-BC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 12, 2018
- Certification date
- Oct 15, 2026
- Last updated
- Oct 15, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 0024176579 | VA | Yes |
| 363LP2300X | Nurse Practitioner, Primary Care | 0024176579 | VA |
Practice location
7864 Richmond Tappahannock HwyAylett, VA 23009-3056
Phone 804-769-2015
Mailing address
3944 Upshaw RdAylett, VA 23009-2912
Phone 804-928-8477
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All 8 Family Medicine Physician providers in Aylett · All 64 providers in Aylett
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