NC 91 begins at an intersection with US 13/US 258/NC 903 north of the main business district of Snow Hill.

Many farms and forests are present along the first several miles of the highway, along with Lenoir Community College and Greene Central High School.

After crossing Washington Branch Church Road, NC 91 passes by several industrial farms.

Running through the unincorporated community of Castoria, the highway passes a fire station and several small homes before turning to the northwest.

Roughly paralleling Sandy Run, the highway continues through a rural area, however more houses are located adjacent to the road, than the section near Snow Hill.

Approaching Evermay Farm Road, the highway turns to the north and then slightly northeast.

In the central part of the town, Wilson Street crosses a railroad operated by Carolina Coastal Railway.

The highway passes by several small businesses and a post office, before leaving the town to the north.

[5] Upon the establishment of the North Carolina state highway system in 1921, this corridor was assigned to NC 91.

The highway was paved between Grimesland and an undefined area east of Jessama in Beaufort County where it became a graded road through Pantego.

As a result, the highway also followed a new routing between Zebulon and Middlesex, with the former alignment becoming a secondary road.

It followed a graded roadway to the northeast, along the southern shoreline of Lake Mattamuskeet from Swanquarter to Engelhard.

In 1932, the establishment of US 264 was approved by the American Association of State Highway Officials (AASHO), running along NC 91 from Zebulon to Englehard.

[18] By 1958, the highway was rerouted near its southern terminus to run directly to Snow Hill instead of using its previous alignment which ended north of the town.