It runs from the Blue Ridge Parkway (mile marker 355) to Mount Mitchell State Park.

Reaching an elevation of over 6,400 feet (2,000 m), it is the highest (of any) road or highway east of the Mississippi River.

The two-lane road has mild curves as it enters Mount Mitchell State Park.

If the Blue Ridge Parkway is closed due to inclement weather, access to NC 128 is cut-off.

[2] In 1922, the first NC 128 existed briefly, originally running from Scotland Neck to Rich Square.