Provider Demographics
NPI:1164746939
Name:DRANE, KENNETH SLOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SLOAN
Last Name:DRANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4635
Mailing Address - Country:US
Mailing Address - Phone:601-445-0740
Mailing Address - Fax:601-897-4210
Practice Address - Street 1:329 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4635
Practice Address - Country:US
Practice Address - Phone:601-445-0740
Practice Address - Fax:601-897-4210
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22888207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2331558Medicaid
MS03029221Medicaid
MS356672ZHKWOtherMEDICARE