The highway is an easy drive, as it nears Spruce Pine, it expands to a four-lane that then bypasses the mountain city.

US 19E reverts to two-lane once out of city limits, briefly widening to four-lane again after entering Avery County.

Most travelers will take turn onto North Carolina Highway 194 (NC 194, Mullen Hill Road; a shortcut bypassing Ingalls) as an alternate route toward Elk Park.

Passing through several small communities, it eventually reaches the town of Elk Park, where it then proceeds into Tennessee.

US 19E travels a total of 45 miles (72 km) from Cane River to the Tennessee state line.

[4][5] US 19 first appeared in Tennessee in 1927, from the North Carolina state line (near Elk Park) to Bluff City.