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

Dominique Stay Tecklenburg, PA-C

Individual provider Physician Assistant · NPI 1639877475

Dominique Stay Tecklenburg, PA-C is a Physician Assistant in Orem, Utah. Qualified in 2022, 4 years ago. Practices with Community Health Partners, a 505-clinician group and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2023
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

435 S 660 W
Orem, UT 84058-6078
Phone: (801) 691-4980
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1639877475
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedFebruary 21, 2023
Last updated in NPPESFebruary 21, 2023
Certification dateFebruary 21, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Community Health Partners — 505 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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