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

Mr. Charles Jay Bawcom, APRN-RNP

Individual provider Family Nurse Practitioner · NPI 1801419841

Mr. Charles Jay Bawcom, APRN-RNP is a Nurse Practitioner in Grand Canyon, Arizona. Qualified in 2020, 6 years ago. Practices with Medical Associates of Northern New Mexico, a 14-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
6
Licensed in
AZ
In the registry since
2020

Practice location Address checks out

1 Clinic Rd # 369
Grand Canyon, AZ 86023-0290
Phone: (928) 638-2551
Fax: (928) 638-2598
Show map & directions

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

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 241530 (AZ)

Record details

NPI number1801419841
Entity typeIndividual (Type 1)
GenderMale
Credentials APRN-RNP
Sole proprietorNo
NPI enumeratedMay 26, 2020
Last updated in NPPESApril 21, 2026
Certification dateApril 21, 2026
Mailing addressPo Box 1231, Tucson, AZ 85702-1231

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Medical Associates Of Northern New Mexico — 14 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Grand Canyon