It travels north from its southern terminus 6 miles (9.7 km) where it passes by Nodaway County Lake on its left and enters Pickering.

Thereafter, it continues northward 2 miles (3.2 km) where it crosses the One Hundred and Two River, and after an additional 5 miles (8.0 km) it enters Hopkins, where it meets the western terminus of Route 246.

Then traveling northeast, it crosses the East fork of the One Hundred and Two River and travels 2 miles (3.2 km) to the IA-MO state line where it becomes Iowa Highway 148.

The part south of Mayville became part of US 71 in 1926, but the rest remained until it was renumbered to match Iowa Highway 148 in 1969.

On September 14, 1933, Route 148 (then Route 27) north of Hopkins was the scene of a gun fight between the Missouri Highway Patrol and Harold B. Thornbrugh, a Kansas outlaw who was wanted for the murder of Omaha, Nebraska special duty police officer Otto Peterson.