Known as Dunlap Creek Road, the state highway runs 11.33 miles (18.23 km) from SR 311 at Crows north to Interstate 64 (I-64) and U.S. Route 60 (US 60) at Callaghan.

SR 159 forms part of the old alignment of US 60 in western Alleghany County.

SR 159 passes through the hamlets of Hematite and Moss Run within the valley.

As the state highway approaches Callaghan, it veers away from the creek and passes under CSX's Alleghany Subdivision.

The state highway crosses Dunlap Creek once more before terminating within its partial diamond interchange with I-64 and US 60, which runs concurrently with I-64 west from the interchange toward West Virginia.