ND 19 begins at the McHenry–Pierce county line traveling east as a continuation of CR 19.

After this intersection, the route heads northeast for two miles and forms the northern border of the Buffalo Lake National Wildlife Refuge, crossing Buffalo Lake in the process.

Less than a mile farther east, ND 19 meets its eastern terminus at a junction with ND 20.

[1] The majority of ND 19, the portion from its eastern terminus in Devils Lake to its junction with ND 3, was completed in 1939 and was the original alignment of the route.

The small portion from ND 3 to its current western terminus at the McHenry–Pierce county line was completed between 1965 and 1975.