RAVEN CUSTALOW (AGPCNP-BC) – Primary Care Nurse Practitioner, NPI 1669955019
Primary Care Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,303 NURSE PRACTITIONER in VA
Loading map...
Provider Addresses for RAVEN CUSTALOW (AGPCNP-BC)
359, Nottoway Lane, King William County, Virginia, 23086, United States
KING WILLIAM, VA 230863658
Phone: (804) 928-8477
Type: Mailing
17452, Richmond Road, Luttrellville, Callao, Northumberland County, Virginia, 22435, United States
CALLAO, VA 22435
Phone: (804) 529-6141
Type: Location
3944 UPSHAW RD
AYLETT, VA 230092912
Phone: (804) 928-8477
Type: Mailing
7864 RICHMOND TAPPAHANNOCK HWY
AYLETT, VA 230093056
Phone: (804) 769-2015
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20241104002126 | I | Nurse Practitioner | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 23086)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| General Practice | VA | |
| Mental Health Counselor | VA | |
| Pediatric Medicine | CA | |
| Nurse Practitioner | VA | |
| Nurse Practitioner | VA |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.